Medical use for tachykinin antagonists

ABSTRACT

The present invention relates to the use of certain tachykinin antagonists, including substance P antagonists and other neurokinin antagonists, in the treatment of emesis.

This application is a continuation of application Ser. No. 08/214,306, filed Mar. 17. 1994, now U.S. Pat No. 5,547,964 allowed.

The present invention relates to the use of certain tachykinin antagonists, including substance P antagonists and other neurokinin antagonists, in the treatment of emesis.

Tachykinin antagonists are known to be useful in the treatment of a variety of disorders including pain, inflammatory diseases, allergic disorders, CNS disorders, skin disorders, cough and gastrointestinal disorders such as ulcerative colitis and Crohn's disease.

It has now been found that tachykinin antagonists, including substance P antagonists and other neurokinin antagonists, are useful in the treatment of emesis. Our co-pending European Patent Application No. 92202831 (Publication No. 0533280) relates to the use of tachykinin antagonists in the treatment of emesis.

The use of the tachykinin antagonists, including substance P antagonists and other neurokinin antagonists, specifically disclosed in co-pending European Patent Application No. 92202831 in the treatment of emesis is not included within the scope of the present invention.

The invention accordingly provides, in a first aspect, the novel use of the tachykinin antagonists, including substance P antagonists and other neurokinin antagonists, generically and specifically disclosed in published European Patent Application Nos. 512901, 512902, 514273, 514275, 517589, 520555, 522808, 528495, 532456 and published PCT Patent Application Nos. 92/15585, 92/17449, 92/20661, 92/20676, 92/21677, 92122569, 93/00331, 93/01159, 93/01160, 93/01165, 93/01169 and 93/01170, which disclosures are incorporated herein by reference, in the treatment of emesis.

There is also provided as a further aspect of the invention the use of the tachykinin antagonists, including substance P antagonists and other neurokinin antagonists, generically and specifically disclosed in the above referenced patent specifications in the preparation of a medicament for use in the treatment of emesis.

In an alternative or further aspect there is provided a method for the treatment of a mammal, including man, suffering from or susceptible to emesis, comprising administration of an effective amount of a tachykinin antagonist, including substance P antagonists and other neurokinin antagonists, generically or specifically disclosed in the above referenced patent specifications.

It will be appreciated that reference to treatment is intended to include prophylaxis as well as the alleviation of established symptoms.

Tachykinin antagonists, including substance P antagonists and other neurokinin antagonists, disclosed in the above referenced patent specifications have been shown to have anti-emetic activity as indicated by for example their ability to inhibit cisplatin- or radiation-induced emesis in the ferret.

The treatment of emesis mentioned hereinbefore includes the treatment of nausea, retching and vomiting. Emesis includes acute emesis, delayed emesis and anticipatory emesis. Tachykinin antagonists, including substance P antagonists and other neurokinin antagonists, are useful in the treatment of emesis however induced. For example, emesis may be induced by drugs such as cancer chemotherapeutic agents such as alkylating agents, e.g. cyclophosphamide, carmustine, lomustine and chlorambucil; cytotoxic antibiotics, e.g. dactinomycin, doxorubicin, mitomycin-C and bleomycin; anti-metabolites, e.g. cytarabine, methotrexate and 5-fluorouracil; vinca alkaloids, e.g. etoposide, vinblastine and vincristine; and others such as cisplatin, dacarbazine, procarbazine and hydroxyurea; and combinations thereof; radiation sickness; radiation therapy, e.g. irradiation of the thorax or abdomen, such as in the treatment of cancer; poisons; toxins such as toxins caused by metabolic disorders or by infection, e.g. gastritis; pregnancy; vestibular disorders, such as motion sickness and vertigo; post-operative sickness; gastrointestinal obstruction; reduced gastrointestinal motility; visceral pain, e.g. myocardial infarction or peritonitis; migraine; increased intercranial pressure; decreased intercranial pressure (e.g. altitude sickness); and opioid analgesics, such as morphine.

Tachykinin antagonists acting at NK₁ receptors have been found to be particularly useful in the treatment of emesis.

In a preferred aspect therefore the invention provides the use of an NK₁ receptor antagonist generically or specifically disclosed in the above referenced patent specifications in the treatment of emesis.

Particularly preferred tachykinin antagonists for use in the present invention include those generically and specifically disclosed in:

EP512901, i.e. compounds of the formula

wherein

Y represents a group Cy-N or Cy-CH₂—N wherein

Cy represents phenyl optionally substituted by one or more groups, which may be the same or different, selected from halogen, hydroxy, C₁₋₄alkoxy, C₁₋₄alkyl, trifluoromethyl; C₃₋₇cycloalkyl; pyrimidinyl; or pyridyl;

or Y represents a group Ar—(CH₂)_(x)C(X)— wherein

Ar represents phenyl optionally substituted by one or more groups, which may be the same or different, selected from hydrogen, halogen, hydroxy, C₁₋₄alkoxy, trifluoromethyl, C₁₋₄alkyl; pyridyl; or thienyl; x is zero or 1;

X represents hydrogen, hydroxy, C₁₋₄alkoxy, C₁₋₄acyloxy, carboxy, C₁₋₄alkoxycarbonyl, cyano, a group N(X₁)₂ wherein X₁ represents independently hydrogen, C₁₋₄alkyl, hydroxy C₁₋₄alkyl, C₁₋₄acyl or -(X₁)₂ represents, together with the nitrogen atom to which it is attached, a heterocycle selected from pyrrolidine, piperidine or morpholine; a group —S—X₂ wherein X₂ represents hydrogen or C₁₋₄alkyl; or X forms a double bond with an adjacent carbon atom;

m is 2 or 3;

Ar¹ represents phenyl optionally substituted by one or more groups, which may be the same or different, selected from halogen, preferably chlorine or fluorine, trifluoromethyl, C₁₋₄alkoxy, C₁₋₄alkly; thienyl; benzothienyl; naphthyl; or indolyl;

n is zero 1, 2 or 3;

p is 1 or 2 provided that p is 2 when n is 1 and Q represents two hydrogen atoms;

Q represents oxygen or two hydrogen atoms;

T represents a group selected from C(O) and —CH₂—;

q is zero, 1, 2 or 3;

Z represents phenyl optionally substituted by one or more groups selected from halogen, more particularly chlorine or fluorine, trifluoromethyl, C₁₄alkyl, hydroxyl, C₁₋₄alkoxy; naphthyl optionally substituted by one or more groups selected from halogen, trifluoromethyl, C₁₋₄alkyl, hydroxyl; pyridyl; thienyl; indolyl; quinolyl; benzothienyl; imidazolyl; or in addition when T represents C(O), —(CH₂)_(q)—Z may also represent a benzyl group substituted on the —CH — by hydroxy, C₁₋₄alkoxy or C₁₋₄alkyl group and optionally substituted on the aromatic ring by halogen, more particularly chlorine or fluorine, trifluoromethyl, C₁₋₄alkyl, hydroxy, C₁₋₄alkoxy; or an optionally substituted mono-, bi- or tricyclic aromatic or heteroaromatic group; and salts thereof with mineral or organic acids, or, where Y represents Ar—(CH₂)_(x)—C(X)—, quarternary ammonium salts or N-oxides formed with the piperidine nitrogen atom (b).

EP 512902, i.e. compounds of the formula

wherein

Ar¹ represents phenyl optionally substituted by halogen, C₁₋₃alkyl, trifluoromethyl, C₁₋₃alkoxy or hydroxy; thienyl, pyridyl or naphthyl optionally substituted by halogen; indolyl; or benzothienyl;

R represents hydrogen, methyl or (CH₂)_(n)L;

n represents 2 to 6;

L represents hydrogen or amino;

Z and Z¹ represent hydrogen, M or OM;

M represents hydrogen, C₁₋₆alkyl, a-hydroxybenzyl, a-(C₁₋₃alkyl) benzyl, phenylC₁₋₃alkyl (optionally ring substituted by halogen, hydroxy, C₁₋₄alkoxy or C₁₋₄alkyl), pyridylC₁₋₃alkyl, naphthylC₁₋₃alkyl, pyridylthioC₁₋₃alkyl, styryl, 1-methyl-2-imidiazolylthioC₁₋₃alkyl, 1-oxo-3-phenyl-2-indanyl, or optionally substituted aryl or heteroaryl;

T¹=a bond, CH₂ or CO;

T=CO or C(W)NH;

W=O or S;

with the proviso that (a) T¹ is not a bond when Z¹ is hydrogen or OM; and (b) T is not C(W)NH when Z is hydrogen or OM;

and acid addition and quarternary ammonium salts thereof.

EP 514273, i.e. compounds of the formula

wherein

R each represent hydrogen or together form a bond;

R¹ are the same and represent phenyl optionally substituted in the 2- or 3-position by halogen or methyl;

X represents O or NH;

R₁ represents phenyl optionally substituted by one or more halogen, hydroxy, alkyl (optionally substituted by halogen, amino, alkylamino or dialkylamino), alkyloxy or alkylthio (both optionally substituted by hydroxy, amino, alkylamino, dialkylamino (optionally substituted by phenyl, hydroxy or amino) or dialkylamino where the alkyl groups form, together with the nitrogen atom to which they are attached, a 5- or 6-membered heterocyclic ring which may contain a further heteroatom selected from oxygen, sulfur or nitrogen, optionally substituted by alkyl, hydroxy or hydroxyalkyl), or substituted by amino, alkylamino, dialkylamino (where the alkyl groups, together with the nitrogen atom to which they are attached, may form a heterocycle as defined above), or R₁ represents cyclohexadienyl, naphthyl, or a 5-9-membered mono— or polyheterocyclic ring, optionally saturated, and containing one more heteroatoms selected from oxygen, nitrogen and sulfur;

R₂ represents hydrogen, halogen, hydroxy, alkyl, aminoalkyl, alkylaminoalkyl, dialkylaminoalkyl, alkyloxy, alkylthio, acyloxy, carboxy, alkyloxycarbonyl, dialkylaminoalkyloxycarbonyl, benzyloxycarbonyl, amino, acylamino, or alkyloxycarbonylamino;

R₃ represents halogen or hydroxy;

R₄ represents hydrogen; or R₃ and R₄ are both halogen; and salts thereof.

EP 514275, i.e. compounds of the formula

wherein X represents NH or an oxygen atom;

R₁ represents phenyl optionally substituted by one or more groups selected from halogen, hydroxy, alkyl (optionally substituted by halogen, amino, alkylamino or dialkylamino), alkyloxy or alkylthio [optionally substituted by hydroxy, amino, alkylamino or dialkylamino (optionally substituted by phenyl, hydroxy or amino), or dialkylamino where the alkyl groups form, together with the nitrogen atom to which they are attached, a 5- or 6-membered heterocyclic ring optionally containing a further heteroatom selected from oxygen, sulphur or nitrogen, optionally substituted by alkyl, hydroxy or hydroxyalkyl], or substituted by amino, alkylamino, dialkylamino where the alkyl groups optionally form, together with the nitrogen atom to which they are attached, a heterocycle as defined above, or represent a cyclohexadienyl, naphthyl or a mono or polycylic, saturated or unsaturated, ring containing 5 to 9 carbon atoms and one or more heteroatoms selected from oxygen, nitrogen or sulphur;

R₂ represents hydrogen, halogen, hydroxy, alkyl, aminoalkyl, alkylaminoalkyl, dialkylaminoalkyl, alkyloxy, alkylthio, acyloxy, carboxy, alkyloxycarbonyl, dialkylaminoalkyloxycarbonyl, benzyloxycarbonyl, amino, alkylamino or alkyloxycarbonylamino; n is an integer from zero to 2; and salts thereof. EP 520555, i.e. compounds of the formula (E) or a salt or produce thereof

wherein

Q is the residue of an optionally substituted azabicyclic ring system;

X represents oxa or thia;

Y represents H or hydroxy;

R¹ represents phenyl or thienyl, either of which groups may be optionally substituted by halo, trifluoromethyl or C₁₋₃ alkoxy, or C₅₋₇cycloalkyl;

R² represents benzyl which may be substituted in the benzyl ring by halo, trifluoromethyl or C₁₋₃alkoxy, or C₅₋₇ cycloalkyl; and

R³, R⁴ and R⁵ independently represent H. C₁₋₆ alkyl, C₂₋₆ alkenyl, C₂₋₆ alkynyl, halo, cyano, nitro, trifluoromethyl, trimethylsilyl, —OR^(a), SCH₃, SOCH₃, SO₂CH₃, —NR^(a)R^(b), —NR^(a)COR^(b), —NR^(a)CO₂R^(b), —CO₂R^(a) or —CONR^(a)R^(b); and

R^(a)and R^(b) independently represent H, C₁₋₆ alkyl, phenyl or trifluoromethyl.

EP 522808, i.e compounds of formula (F) or a salt or prodrug thereof

wherein

Q represents R⁹CR¹⁰R¹¹ or CH₂R⁹CR¹⁰ R¹¹ where R⁹ is H or hydroxy and R¹⁰ and R¹¹ each independently represent optionally substituted phenyl, optionally substituted benzyl, C₅₋₇ cycloalkyl or (C₅₋₇ cycloalkyl) methyl;

R¹ and R² independently represent H; C₁₋₆ alkyl optionally substituted by hydroxy, cyano, COR^(a), COOR^(a), CONR^(a)R^(b), COC₁₋₆alkylNR^(a)R^(b), CONR¹²C₁₋₆alkylOR^(a), CONR¹²C₁₋₆alkylCONR^(a)R^(b) or NR^(a)R^(b) (where R^(a) and R^(b) each independently represent H, C₁₋₆alkyl, phenyl (optionally substituted by one or more of C₁₋₆alkyl, C₁₋₆alkoxy, halo and trifluoromethyl), phenyl(C₁₋₄alkyl) (optionally substituted in the phenyl ring by one or more of C₁₋₆alkyl, C₁₋₆alkoxy, halo and trifluoromethyl) or R^(a) and R^(b) together form a chain (CH₂)p optionally substituted by oxo where p is 4 or 5 and where one methylene group may optionally be replaced by an oxygen atom or a group NR^(x), where R^(x) is H or C₁₋₆alkyl, and R¹² represents H, C₁₋₆alkyl, phenyl (optionally substituted by one or more of C₁₋₆alkyl, C₁₋₆alkoxy, halo and trifluoromethyl) or phenyl (C₁₋₄alkyl) (optionally substituted in the phenyl ring by one or more of C₁₋₆alkyl, C₁₋₆alkoxy, halo and trifluoromethyl); phenyl(C₁₋₄alkyl) (optionally substituted by one or more of C₁₋₆alkyl, C₁₋₆alkoxy, halo and trifluoromethyl in the phenyl ring); C₂₋₆alkenyl; C₂₋₆alkynyl; COR^(a); COOR^(a), COC₁₋₆alkylhalo; COC₁₋₆alkylNR^(a)R^(b); CONR¹²C₁₋₆alkylCONR^(a)R^(b); CONR^(a) R^(b) or SO₂R^(a); (where R^(a), R^(b) and R¹² are as previously defined) or R¹ and R² together form a chain (CH₂)_(q) optionally substituted by oxo where q is 4 or 5 and where one methylene group may optionally be replaced by an oxygen atom or a group NR^(x), where R^(x) is H or C₁₋₆alkyl;

R³ represents H, C₁₋₆alkyl or C₂₋₆alkenyl;

R⁴ represents C₁₋₃alkyl substituted by a phenyl group which may itself optionally be substituted by one or more of C₁₋₆alkyl, C₂₋₆alkenyl, C₂₋₆alkynyl, halo, cyano, nitro, trifluoromethyl, trimethylsilyl, SR^(c), SOR^(c), SO₂R^(c), OR^(c), NR^(c)R^(d), NR^(c) COR^(d), NR^(c)COOR^(d), COOR^(c)and CONR^(c)R^(d), where R^(c) and R^(d) independently represent H, C₁₋₆alkyl, phenyl or trifluoromethyl;

X and Y each represent H, or X and Y together represent a group ═O; and

Z represents O, S or NR⁷, where R⁷ represents H or C₁₋₆alkyl;

with the exception of

DL-diphenylalanine benzyl ester;

2-benzamido-3,3-diphenylpropanoyl benzamide; and

2-benzamido-3,4-diphenyl-butanoyl benzamide.

For example 2-ammonium-1-((3,5-bis(trifluoromethyl)phenyl)methyloxy)-3,3-diphenylpropane-Compound 1; and salts and prodrugs thereof.

EP 528495, i.e. compounds of formula (G) or a salt or prodrug thereof

wherein

n is 1, 2, or 3 and where any carbon atom of (CH₂)n may be substituted by R⁴ and/or R⁵;

X represents O or S;

R¹ represents phenyl optionally substituted by 1, 2 or 3 groups selected from C₁₋₆alkyl, C₂₋₆alkenyl; C₂₋₆alkynyl, halo, cyano, nitro, trifluoromethyl, trimethylsilyl, —OR^(a), SR^(a), SOR^(a), SO₂R^(a), —NR^(a)R^(b), —NR^(a)COR^(b), —NR^(a)CO₂R^(b), CO₂R^(a)or —CONR^(a)R^(b).

R² represents aryl selected from phenyl and naphthyl; heteroaryl selected from indazolyl, thienyl, furyl, pyridyl, thiazolyl, tetrazolyl and quinolyl; benzhydryl; or benzyl; wherein each aryl or heteroaryl moiety may be substituted by C₁₋₆alkyl, C₁₋₆alkoxy, halo or trifluoromethyl;

R⁴ and R⁵ each independently represent H, halo, CH₂OR⁹, C₁₋₆alkyl, oxo, CO₂R¹⁰ or CONR¹⁰R¹¹;

R⁸ represents H, COR⁹, CO₂R¹⁰, COCONR¹⁰R¹¹, COCO₂R¹⁰ or C₁₋₆alkyl optionally substituted by a group selected from (CO₂R¹⁰, CONR¹⁰R¹¹, hydroxy, cyano, COR⁹, NR¹⁰R¹¹, C(NOH)NR¹⁰R¹¹, CONHphenyl-(C₁₋₄alkyl), COCO₂R¹⁰, COCONR¹⁰R¹¹ and phenyl optionally substituted by one or more substituents selected from C₁₋₆alkyl, C₁₋₆alkoxy, halo and trifluoromethyl);

R^(a)and R^(b) each independently represent H, C₁₋₆alkyl, phenyl or trifluoromethyl;

R⁹ represents H, C₁₋₆alkyl or phenyl; and

R¹⁰ and R¹¹ each independently represent H or C₁₋₆alkyl.

For example cis-3-((3,5-dimethylphenyl)methyloxy)-2-phenylpiperidine Compound 5; and salts (e.g. the hydrochloride salt) and prodrugs thereof. WO 92/22569, i.e. compounds of formula

wherein R¹ is lower alkyl, aryl, ar(lower)alkyl, arylamino, pyridyl, pyrrolyl, pyrazolopyridyl, quinolyl, or a group of the formula

wherein the symbol of a line and dotted line is a single bond or a double bond,

X is CH or N, and

Z is O, S or NH,

each of which may have suitable substituent(s);

R² is hydrogen or lower alkyl;

R³ is hydrogen or suitable substituent;

R⁴ is lower alkyl which may have suitable substituent(s), and

R⁵ is ar(lower)alkyl which may have suitable substituent(s) or pyridyl (lower) alkyl, or

R⁴ and R⁵ are linked together to form benzene-condensed lower alkylene;

A is an amino acid residue which may have suitable substituent(s); and

Y is bond, lower alkylene, lower alkenylene or lower alkylimino, provided that when

R¹ is aryl, or a group of the formula:

wherein X is as defined above, and

Z is O or N—R⁶ _(a), in which R⁶ _(a) is hydrogen or lower alkyl,

R² is hydrogen,

R⁴ is lower alkyl which may have suitable substituent(s),

R⁶ is ar(lower)alkyl which may have suitable substituent(s),

A is group of the formula:

wherein R⁷ is hydroxy or lower alkoxy, and

Y is bond or lower alkenylene, then

R³ is suitable substituent.

WO 92/15585, i.e. compounds of the formula

wherein R¹, R², R³, R⁴, R⁵, and R⁶ are each independently selected from hydrogen, fluorine, chlorine, bromine, trifluoromethyl, alkyl having from one to three carbon atoms, alkoxy having from one to three carbon atoms, carboxy, alkoxycarbonyl having from one to three carbon atoms in the alkoxy moiety, and benzyloxycarbonyl; and the pharmaceutically acceptable salts of such compounds.

WO 92/17449, i.e. compounds of the formula

wherein R¹ is aryl selected from indanyl, phenyl and naphthyl; heteroaryl selected from thienyl, furyl, pyridyl and quinolyl; and cycloalkyl having 3 to 7 carbon atoms, wherein one of said carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said (C₃-C₇) cycloalkyl may optionally be substituted with one or two substituents, said substituents being independently selected from chloro, fluoro, bromo, iodo, nitro, (C₁-C₁₀) alkyl optionally substituted from one to three fluoro groups, (C₁-C₁₀) alkoxy optionally substituted with from one to three fluoro groups, amino, (C₁-C₁₀)alkyl-S—, (C₁-C₁₀)alkyl-S(O)—, (C₁-C₁₀)alkyl-SO₂—, phenyl, phenoxy, (C₁-C₁₀)alkyl-SO₂NH—, (C₁-C₁₀)alkyl-SO₂NH—(C₁-C₁₀)alkyl-, (C₁-C₁₀)alkylamino-di(C₁-C₁₀)alkyl-, cyano, hydroxy, cycloalkoxy having 3to 7 carbon atoms, (C₁-C₆)alkylamino, (C₁-C₆)dialkylamino, HC(O)NH— and (C₁-C₁₀)alkyl-C(O)—NH—, wherein the nitrogen atoms of said amino and (C₁-C₆) alkylamino groups may optionally be protected with an appropriate protecting group; and R² is thienyl , benzhydryl, naphthyl or phenyl optionally substituted with from one to three substituents independently selected from chloro, bromo, fluoro, iodo, cycloalkoxy having 3 to 7 carbon atoms, (C₁-C₁₀)alkyl optionally substituted with from one to three fluoro groups and (C₁-C₁₀)alkoxy optionally substituted with from one to three fluoro groups.

For example

(2S,3S)-3-(2-Methoxy-5-methylmercaptobenzylamino)-2-phenylpiperidine-Compound 2.

WO 92120661, i.e. compounds of the formula

or a pharmaceutically acceptable salt thereof wherein:

R^(1a) is

1) H,

2) C₁₋₈ alkyl,

3) phenyl, either unsubstituted or substituted with one or two substituents selected from:

a) —C₁₋₄ alkyl,

b) -halo,

e) —OH,

d) —CF₃,

e) —NH₂,

f) —NH(C₁₋₄ alkyl),

g) —N(C₁₋₄ alkyl)₂,

h) —CO₂H,

i) —CO₂(C₁₋₄ alkyl), and

j) —C₁₋₄ alkoxy; or

4) C₁₋₄ alkyl-phenyl, wherein the phenyl is either unsubstituted or substituted with one or two substituents selected from:

a) —C₁₋₄ alkyl,

b) -halo,

e) —OH,

d) —CF₃

e) —NH₂,

f) —NH(C₁₋₄ alkyl),

g) —N(C₁₋₄ alkyl)₂,

h) —CO₂H

i) —CO₂(C₁₋₄ alkyl), and

j) —C₁₋₄ alkoxy;

R^(1b) is

1) R^(1a),

2) —C₃₋₇ cycloalkyl, or

3) —CH₂-R^(1a);

R^(2a) and R^(2b) are independently phenyl, either unsubstituted or substituted with one or two substituents selected from:

1) —C₁₋₄ alkoxy,

2) -halo,

3) —OH,

4) —CF₃,

5) —NH₂,

6) —NH(C₁₋₄ alkyl),

7) —N(C₁₋₄ alkyl)₂,

8) —CO₂H,

9) —CO₂(C₁₋₄ alkyl), and

10) —C₁₋₆ alkyl, either unsubstituted or substituted with:

a) -halo,

b) —OH,

c) —CF₃,

d) —NH₂,

e) —NH(C₁₋₄ alkyl),

f) —N(C₁₋₄ alkyl)₂,

g) —CO₂H,

h) —CO₂(C₁₋₄ alkyl), and

i) —C₁₋₄ alkoxy,

j) —S(O)_(x)(C₁₋₄ alkyl) wherein x is 0, 1 or 2,

k) —C₃₋₇ cycloalkyl;

and the phenyl groups of R^(2a) and R^(2b) may be joined together at the ortho carbon atoms through a carbon-carbon single bond or C₁₋₃ alkylene to form a tricyclic group with the X² to which they are attached;

X¹ is —N, —CH or O, and if X¹ is O, R_(1a) is absent:

X² is —N or —CH;

R³ is

1) —C₁₋₄ alkyl,

2) —CO₂R⁶,

3) —CH₂OCOR⁶,

4) —CH₂OH,

5) —CH₂OR⁵,

6) —CH₂S(O)_(x)R⁵,

7) —CH₂OCONR⁵R⁶,

8) —CH₂CONR⁵R⁶,

9) CONR⁵R⁶,

10) —CO₂R⁸,

11) —CH₂CO₂R⁶,

12) —CH₂CO₂R⁸,

13) —CONHSO₂R⁹,

14) —CH₂N(R⁶)CONR⁵R⁶,

15) —CH₂NH₂,

16) —CH₂NH(C₁₋₄ alkyl), or

17) —CH₂N(C₁₋₄alkly)₂; wherein

R⁵ is C₁₋₆ alkyl either unsubstituted or substituted with:

1) -halo,

2) —OH,

3) —CF₃

4) —NH₂,

5) —NH(C₁₋₄ alkyl),

6) —N(C₁₋₄ alkyl)₂,

7) —CO₂H,

8) —CO₂(C₁₋₄ alkyl),

9) —C₃₋₇ cycloalkyl, or

10) phenyl, either unsubstituted or substituted with

a) —C₁₋₄ alkyl,

b) -halo,

c) —OH,

d) —CF₃

e) —NH₂,

f) —NH(C₁₋₄ alkyl),

g) —N(C₁₋₄ alkyl)₂,

h) —CO₂H, or

i) —CO₂(C₁₋₄ alkyl);

R⁶ is —H or C₁₋₄ alkyl; or

R⁵ and R⁶ can be joined together to form with the nitrogen to which they are attached —N(CH₂CH₂)₂L; wherein L is:

i) a single bond,

ii) —CH₂—,

iii) —O—,

iv) —S(O)_(p)—,or

v) —NR⁷;

R⁷ is

1) —H,

2) —C₁₋₆ alkyl, unsubstituted or substituted with —OH, —C₁₋₄ alkoxy or —N(C₁₋₄alkyl)₂,

3) —aryl, or

4) —CH₂—aryl;

R⁸ is

1) —H,

2) —CH (R⁷) OCOR¹⁰, wherein R¹⁰ is a) —C₁₋₆alkyl, b) —aryl, or c) —CH₂—aryl,

3) —CH₂—aryl,

R⁹ is

1) —aryl,

2) —heteroaryl,

3) —C₃₋₇cycloalkyl,

4) —polyfluoro-C₁₋₄alkyl

5) —C₁₋₆alkyl, either unsubstituted or substituted with

a) —aryl,

b) —heteroaryl,

c) OH,

d) —SH,

e) —C₁₋₄alkyl,

f) —C₃₋₇cycloalkyl,

g) —C₁₋₄alkoxy

h) —C₁₋₄alkylthio,

i) —CF₃,

i) -halo,

k) —NO₂,

l) —CO₂R⁶,

m) —N(R⁶)₂, wherein the R⁶ groups are the same or different,

n) —NH—aryl,

o) —N(aryl)₂,

p) —PO₃H,

q) —PO(OH)(OC₁₋₄alkyl) or

r) —N(CH₂CH₂)₂L wherein L is as defined above, and

R⁴ is H or R³.

WO 92/20676, i.e. compounds of the formula

wherein W is Y or X(CH₂)n;

Y is optionally substituted (C₁-C₆) alkyl, optionally substituted (C₂-C₆) alkenyl or optionally substituted (C₃-C₆)cycloalkyl;

X is optionally substituted (C₁-C₆)alkoxy, CONR¹R², CO₂R¹, CHR¹OR², CHR¹NR²R³, COR¹, CON R¹OR² or optionally substituted aryl, wherein said aryl is selected from phenyl, naphthyl, pyridyl, quinolyl, thienyl, furyl, phenoxyphenyl, oxazolyl, tetrazolyl, thiazolyl, imidazolyl and pyrazolyl; and n is an integer from zero to six;

Ar¹, Ar² and Ar³ are each, independently, optionally substituted aryl, wherein said aryl is selected from phenyl, naphthyl, pyridyl, quinolyl, thienyl, furyl, phenoxyphenyl, oxazolyl, tetrazolyl, thiazolyl, imidazolyl and pyrazolyl;

and R¹, R² and R³ are independently selected from hydrogen, optionally substituted (C₁-C₆)alkyl, optionally substituted (C₁-C₆)alkoxy, optionally substituted (C₃-C₈)cycloalkyl, optionally substituted aryl, wherein said aryl is selected from phenyl, naphthyl, pyridyl, quinolyl, thienyl, furyl, phenoxyphenyl, oxazolyl, tetrazolyl, thiazolyl, imidazolyl and pyrazolyl; and optionally substituted (C₁-C₅)heterocyclic groups, wherein said heterocyclic groups are selected from pyrrolidino, piperidino, morpholino, piperazinyl and thiamorpholino;

and wherein the substituents on the foregoing substituted alkyl, alkenyl, cycloalkyl and alkoxy groups are independently selected from halo, nitro, amino, (C₁-C₄) alkyl, (C₁-C₄)alkoxy, trifluoromethyl and trifluoromethoxy;

and wherein the substituents on the foregoing substituted heterocyclic groups are attached to an oxygen or nitrogen atom on the ring and are independently selected from oxygen and (C₁-C₄)alkyl;

and wherein the substituents on said substituted Ar¹ groups are independently selected from (C₁-C₆)alkyl optionally substituted with from one to three halo groups. (C₁-C₆)alkoxy optionally substituted from one to three halo groups, (C₁-C₆)alkylsulfinyl, (C₂-C₆)alkenyl, (C₁-C₆)alkylthio, (C₁-C₆)alkylsulfonyl, (C₁-C₆)alkylsulfonylamino, and di-(C₁-C₆)alkylamino wherein one or both of the alkyl groups may be optionally substituted with a (C₁-C₆)alkylsulfonyl, or (C₁-C₆)alkylsulfinyl group;

and wherein the substituents on said substituted Ar² and Ar³ groups are independently selected from (C₁-C₄)alkyl, (C₁-C₄)alkoxy, (C₁-C₄)alkylthio, (C₁-C₄)alkylsulfinyl, di-(C₁-C₄)alkylamino, trifluoromethyl and trifluoromethoxy,

and wherein the substituents on said substituted (C₁-C₅) heterocyclic groups are independently selected from oxygen and (C₁-C₄)alkyl.

WO 92/21677, i.e. compounds of the formula

wherein R¹ is methoxy and R² is independently selected from the group consisting of isopropyl, tert-butyl, methyl, ethyl and sec-butyl; and the pharmaceutically acceptable salts of such compounds.

WO 93/00331, i.e. compounds of the formula

wherein X¹ is hydrogen, (C₁-C₁₀) alkoxy optionally substituted with from one to three fluorine atoms or (C₁-C₁₀) alkyl optionally substituted with from one to three fluorine atoms;

X² and X³ are independently selected from hydrogen, halo, nitro, (C₁-C₁₀) alkyl optionally substituted with from one to three fluorine atoms, (C₁-C₁₀) alkoxy optionally substituted with from one to three fluorine atoms, trifluoromethyl, hydroxy, phenyl, cyano, amino, (C₁-C₆)-alkylamino, di-(C₁-C₆)alkylamino, —C(O)—NH—(C₁-C₆)-alkyl, (C₁-C₆) alkyl—C(O)—NH—(C₁-C₆) alkyl, hydroxy(C₁-C₄)alkyl, (C₁-C₄)alkoxy(C₁-C₄)alkyl, —NHC(O)H and —NHC(O)—(C₁-C₆)alkyl; and Q is a group of the formula

wherein R¹ is a radical selected from furyl, thienyl, pyridyl, indolyl, biphenyl and phenyl optionally substituted with one or two substituents independently selected from halo, (C₁-C₁₀) alkyl optionally substituted with from one to three fluorine atoms, (C₁-C₁₀) alkoxy optionally substituted with from one to three fluorine atoms, carboxy, benzyloxycarbonyl and (C₁-C₃) alkoxy-carbonyl; R¹³ is selected from (C₃-C₄) branched alkyl, (C₅-C₆) branched alkenyl, (C₅-C₇)cycloalkyl, and the radicals named in the definition of R¹;

R² is hydrogen or (C₁-C₆) alkyl;

R³ is phenyl, biphenyl, naphthyl, pyridyl, benzhydryl, thienyl or furyl, and R³ may optionally be substituted with from one to three substituents independently selected from halo, (C₁-C₁₀) alkyl optionally substituted with from one to three fluorine atoms and (C₁-C₁₀) alkoxy optionally substituted with from one to three fluorine atoms;

Y is (CH₂)_(l) wherein l is an integer from one to three or Y is a group of the formula

Z is oxygen, sulfur, amino, (C₁-C₃)alkylamino or (CH₂)n wherein n is zero, one or two;

o is two or three;

p is zero or one;

R⁴ is furyl, thienyl, pyridyl, indolyl, biphenyl, or phenyl optionally substituted with one or two substituents independently selected from halo, (C₁-C₁₀) alkyl optionally substituted with from one to three fluorine atoms, (C₁-C₁₀) alkoxy optionally substituted with from one to three fluorine atoms, carboxy, (C₁-C₃) alkoxy-carbonyl and benzyloxycarbonyl;

R⁵ is thienyl, biphenyl or phenyl optionally substituted with one or two substituents independently selected from halo, (C₁-C₁₀) alkyl optionally substituted with from one to three fluorine atoms and (C₁-C₁₀) alkoxy optionally substituted with from one to three fluorine atoms;

each of the two dashed lines in formula (N) and the dashed line in formula (II) represent an optional double bond that may optionally exist when Q is a group of the formula (II);

X is (CH₂)_(q) wherein q is an integer from 1 to 6, and wherein any one of the carbon-carbon single bonds in said (CH₂)_(q) may optionally be replaced by a carbon-carbon double bond, and wherein any one of the carbon atoms of said (CH₂)_(q) may optionally be substituted with R⁸, and wherein any one of the carbon atoms of said (CH₂)_(q) may optionally be substituted with R⁹;

m is an integer from 0 to 8, and any one of the carbon-carbon single bonds of (CH₂)_(m) may optionally be replaced by a carbon-carbon double bond or a carbon-carbon triple bond, and any one of the carbon atoms of said (CH₂)_(m) may optionally be substituted with R¹¹;

R⁶ is a radical selected from hydrogen, (C₁-C₆) straight or branched alkyl, (C₃-C₇) cycloalkyl wherein one of the carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; aryl selected from biphenyl, phenyl, indanyl and naphthyl; heteroaryl selected from thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; phenyl (C₂-C₆) alkyl, benzhydryl and benzyl, wherein each of said aryl and heteroaryl groups and the phenyl moieties of said benzyl, phenyl (C₂-C₆) alkyl and benzhydryl may optionally be substituted with one or more substituents independently selected from halo, nitro, (C₁-C₁₀) alkyl optionally substituted with from one to three fluorine atoms, (C₁-C₁₀) alkoxy optionally substituted with from one to three fluorine atoms, amino, hydroxy-(C₁-C₆) alkyl, (C₁-C₆) alkoxy-(C₁-C₆)alkyl, (C₁-C₆)-alkylamino, (C₁ -C₆)alkyl-O—C(O)—, (C₁-C₆)alkyl-O—C(O)—C—, (C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—(O)—, (C₁-C₆)alkyl-C(O)—(C₁-C₆)alkyl-O—, (C₁-C₆)alkyl-C—(O), C₁-C₆)alkyl-C(O)—(C₁-C₆)alkyl-, di-(C₁-C₆)alkylamino, —C(O)NH—(C₁-C₆)-alkyl-, (C₁-C₆)alkyl-C(O)—NH—(C₁-C₆)alkyl, -NHC(O)H and —NHC(O)—(C₁-C₆) alkyl; and wherein one of the phenyl moieties of said benzhydryl may optionally be replaced by naphthyl, thienyl, furyl or pyridyl;

R⁷ is hydrogen, phenyl or (C₁-C₆)alkyl;

or R⁶ and R⁷, together with the carbon to which they are attached, form a saturated carbocyclic ring having from 3 to 7 carbon atoms wherein one of said carbon atoms may optionally be replaced by oxygen, nitrogen or sulfur;

R⁸ and R⁹ are each independently selected from hydrogen, hydroxy, halo, amino, oxo (═O), nitrile, hydroxy-(C₁-C₆)alkyl, (C₁-C₆)alkoxy-(C₁-C₆)alkyl, (C₁-C₆)alkylamino, di-(C₁-C₆)alkylamino, (C₁-C₆)alkoxy, (C₁-C₆)alkyl-O—C(O)—, (C₁-C₆)alkyl-O—C(O)—(C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—O, (C₁-C₆)alkyl-C(O)—(C₁-C₆)alkyl-O—, (C₁-C₆)alkyl-C(O)-, (C₁-C₆)alkyl-C(O)—(C₁-C₆)alkyl-, and the radicals set forth in the definition of R⁶;

R¹⁰is NHCR¹², NHCH₂R¹², NHSO₂R¹² or one of the radicals set forth in any of the definitions of R⁶, R⁸ and R⁹;

R¹¹ is oximino (═NOH) or one of the radicals set forth in any of the definitions of R⁶, R⁸ and R⁹; and

R¹² is (C₁-C₆)alkyl, hydrogen, phenyl(C₁-C₆)alkyl or phenyl optionally substituted with (C₁ -C₆)alkyl; and

with the proviso that (a) when m is O, R¹¹ is absent, (b) neither R⁸, R⁹, R¹⁰ nor R¹¹ can form, together with the carbon to which it is attached, a ring with R⁷, (c) when Q is a group of the formula VIII, R⁸ and R⁹ cannot be attached to the same carbon atom, (d) when R⁸ and R⁹ are attached to the same carbon atom, then either each of R⁸ and R⁹ is independently selected from hydrogen, fluoro, (C₁-C₆) alkyl, hydroxy-(C₁-C₆)alkyl and (C₁-C₆)alkoxy-(C₁-C₆)alkyl, or R⁸ and R⁹, together with the carbon to which they are attached, form a (C₃-C₆) saturated carbocyclic ring that forms a spiro compound with the nitrogen-containing ring to which they are attached, (e) the nitrogen of formula (n) can not be double bonded to both Q and the substituted benzyl group to which it is attached, (f) when Q is a group of the formula VII and q is 2 and either R⁸ or R⁹ is 5-hydroxy-(C₁-C₆)alkyl or 5-(C₁-C₆)alkoxy-(C₁-C₆)alkyl, then the other of R⁸ and R⁹ is either 5-(C₁-C₆)alkyl or hydrogen; (g) when Q is a group of the formula VII and q is 2, then neither R⁸ nor R⁹ is 4-hydroxy-(C₁-C₆)alkyl or 4(C₁-C₆)alkoxy-(C₁-C₆)alkyl, and (h) when neither X¹, X² nor X³ is a fluorinated alkoxy group, at least one of R¹, R³, R⁴, R⁵, R⁶, R⁷ and R¹³ is an aryl group substituted with a fluorinated alkoxy group;

pharmaceutically acceptable acid addition and base salts of compounds of the formula N.

For example

(2S,3S)-2-phenyl-3-(2-trifluoromethoxybenzyl )]aminopiperidine-Compound 3; or a salt (e.g. hydrochloride) thereof; and

(2S,3S)-3-(2-methoxy-5-trifluoromethoxybenzyl)amino-2-phenylpiperidine-Compound 6.

WO 93/01159, i.e. compounds of the formula (O) or a salt or prodrug thereof

wherein

Q represents a group

where W represents a bond, O, S, —CH₂CH₂—, —CH═CH— or a group NR⁶, where R⁶ is H or C₁₋₆alkyl and one or both of the phenyl rings may be replaced by a heteroaryl moiety;

X and Y each represent H or X and Y together form a group ═O;

Z represents O, S or NR⁸, where R⁸ represents H or C₁₋₆alkyl;

R¹ and R² independently represent H; C₁₋₆alkyl optionally substituted by hydroxy, cyano, COR^(a), COOR^(a), CONR^(a)R^(b), COC₁₋₄alkylNR^(a)R^(b), CONR^(a)C₁₋₄alkylCONR^(a)R^(b) or NR^(a)R^(b), (where R^(a)and R^(b) each independently represent H, C₁₋₆alkyl, phenyl (optionally substituted by one or more of C₁₋₆alkyl, C₁₋₆alkoxy, halo and trifluoromethyl) or phenyl (C₁₋₄alkyl) (optionally substituted in the phenyl ring by one or more of C₁₋₆alkyl, C₁₋₆ alkoxy, halo and trifluoromethyl)); phenyl(C₁₋₄ alkyl), (optionally substituted by one or more of C₁₋₆alkyl, C₁₋₆ alkoxy, halo and trifluoromethyl in the phenyl ring); C₂₋₆alkylene; COC₁₋₆alkylhalo; COR^(a); COOR^(a); CONHR^(a); COC₁₋₄alkylNR^(a)R^(b); or CONR^(a)C₁₋₄alkylCONR^(a)R^(b); (where R^(a)and R^(b) are as previously defined) or R¹ and R² together form a chain (CH₂)_(p) where p is 4 or 5 and where one non terminal methylene group may optionally be replaced by an oxygen atom or a group NR^(x), where R^(x) is H or C₁₋₆alkyl;

R³ represents H or C₁₋₆alkyl;

R⁴ represents H, C₁₋₆ alkyl or phenyl (optionally substituted by one or more of C₁₋₆ alkyl, C₂₋₆ alkenyl, C₂₋₆alkynyl, halo, cyano, nitro, trifluoromethyl, trimethylsilyl, SR^(c), SOR^(c), SO₂R^(c), OR^(c), NR^(c)R^(d), NR^(c)COR^(d), NR^(c)COOR^(d), COOR^(c) or CONR^(c)R^(d), where R^(c) and R^(d)each independently represent H, C₁₋₆alkyl, phenyl or trifluoromethyl);

R⁵ represents (CH₂)_(q)phenyl, wherein q is 0, 1, 2 or 3 which may optionally be substituted in the phenyl ring by one or more of C₁₋₆ alkyl, C₂₋₆alkenyl, C₂₋₆alkynyl, halo, cyano, nitro, trifluoromethyl, trimethylsilyl, SR^(c), SOR^(c), SO₂R^(c), OR^(c), NR^(c)R^(d), NR^(c)COR^(d), NR^(c)COOR^(d), COOR^(c) or CONR^(c)R^(d), where R^(c)and R^(d)are as above defined;

each R⁷ and R⁸ independently represents C₁₋₆alkyl, C₂₋₆alkenyl, C₂₋₆alkynyl, halo, cyano, nitro, trifluoromethyl, trimethylsilyl, SR^(c), SOR^(c), SO₂R^(c), OR^(c), NR^(c)R^(d), NR^(c)COR^(d), COOR^(c) or CONR^(c)R^(d)where R^(c) and R^(d)are as above defined; and

m and n independently represent 0, 1, 2, 3 or 4.

WO 93/01160, i.e. compounds of the formula (P) or a salt or prodrug thereof

wherein Q represents R⁹CR¹⁰R¹¹ or CH₂R⁹CR¹⁰R¹¹ where R⁹ is H or hydroxy and R¹⁰ and R¹¹ each independently represent optionally substituted phenyl, optionally substituted benzyl, C₅₋₇cycloalkyl or (C₅₋₇cycloalkyl)methyl;

R¹ and R² independently represent H; C₁₋₆alkyl optionally substituted by hydroxy, cyano, COR^(a), COOR^(a), CONR^(a)R^(b), COC₁₋₆alkylNR^(a)R^(b), CONR¹²C₁₋₆alkylOR^(a), CONR¹²C₁₋₆alkylCONR^(a)R^(b) or NR^(a)R^(b) (where R^(a)and R^(b) each independently represent H, C₁₋₆ alkyl, phenyl (optionally substituted by one or more of C₁₋₆alkyl, C₁₋₆alkoxy, halo and trifluoromethyl), phenyl (C₁₋₄alkyl) (optionally substituted in the phenyl ring by one or more of C₁₋₆ alkyl, C₁₋₆ alkoxy, halo and trifluoromethyl) or R^(a)and R^(b) together form a chain (CH₂)_(p) optionally substituted by oxo where p is 4 or 5 and where one methylene group may optionally be replaced by an oxygen atom or a group NR^(x), where R^(x) is H or C₁₋₆alkyl, and R¹² represents H, C₁₋₆alkyl, phenyl (optionally substituted by one or more of C₁₋₆ alkyl, C₁₋₆alkoxy, halo and trifluoromethyl) or phenyl (C₁₋₄alkyl) (optionally substituted in the phenyl ring by one or more of C₁₋₆alkyl, C₁₋₆alkoxy, halo and trifluoromethyl); phenyl (C₁₋₄ alkyl) (optionally substituted by one or more of C₁₋₆ alkyl, C₁₋₆ alkoxy, halo and trifluoromethyl in the phenyl ring); C₂₋₆ alkenyl; C₂₋₆ alkynyl; COR^(a); COOR^(a); COC₁₋₆alkylhalo; COC₁₋₆alkylNR^(a)R^(b); CONR¹²C₁₋₆alkylCONR^(a)R^(b); CONR^(a)R^(b); or SO₂R^(a); (where R^(a), R^(b) and R¹² are as previously defined) or R¹ and R² together form chain (CH₂)_(q) optionally substituted by oxo where q is 4 or 5 and where one methylene group may optionally be replaced by an oxygen atom or a group NR^(x), where R^(x) is H or C₁₋₆ alkyl;

R³ represents H, C₁₋₆ alkyl or C₂₋₆alkenyl;

R⁴ represents C₁₋₃ alkyl substituted by a phenyl group which may itself optionally be substituted by one or more of C₁₋₆alkyl, C₂₋₆ alkenyl, C₂₋₆alkynyl, halo, cyano, nitro, trifluoromethyl, trimethylsilyl, SR^(c), SOR^(c), SO₂R^(c), OR^(c), NR^(c)R^(d), NR^(c)COR^(d), NR^(c)COOR^(d), COOR^(c) and CONR^(c)R^(d), where R^(c)and R^(d)independently represent H, C₁₋₆alkyl, phenyl or trifluoromethyl;

X and Y each represent H, or X and Y together represent a group ═O; and

Z represents O, S or NR⁷, where R⁷ represents H or C₁₋₆ alkyl;

with the exception of

DL -diphenylalanine benzyl ester;

2-benzamido-3,3-diphenylpropanoyl benzamide; and

2-benzamido-3,4-diphenyl-butanoyl benzamide.

WO 93/01165; i.e. compounds of the formula (Q) or a salt or prodrug thereof

wherein

Q represents optionally substituted phenyl, optionally substituted heteroaryl or optionally substituted naphthyl;

X and Y each represent H, C₁₋₆alkyl, C₂₋₆alkenyl or X and Y together form a group ═O;

Z represents O or S;

R¹ represents H; C₁₋₆ alkyl optionally substituted by hydroxy, cyano, COR^(a), COOR^(a), CONR^(a)R^(b), COC₁₋₄alkylNR^(a)R^(b), CONR^(a)C₁₋₄alkylCONR^(a)R^(b), (where R^(a)and R^(b) each independently represent H, C₁₋₆ alkyl, phenyl optionally substituted by one or more of C₁₋₆alkyl, C₁₋₆alkoxy, halo or trifluoromethyl or phenyl (C₁₋₄alkyl) optionally substituted in the phenyl ring by one or more of C₁₋₆ alkyl, C₁₋₆ alkoxy, halo or trifluoromethyl); phenyl (C₁₋₄ alkyl), (optionally substituted in the phenyl ring by one or more of C₁₋₆ alkyl, C₁₋₆ alkoxy, halo or trifluoromethyl); C₂₋₆ alkylene; COR^(a); COOR^(a)CONHR^(a); COC₁₋₆alkylhalo; COC₁₋₆alkylNR^(a)R^(b); or CONRAC₁₋₆alkylCONR^(a)R^(b), where R^(a)and R^(b) are as previously defined;

R² represents C₁₋₆ alkyl substituted by hydroxy, cyano, COR^(a), COOR^(a), CONR^(a)R^(b), COC₁₋₄alkylNR^(a)R^(b), CONR^(a)C₁₋₄alkylCONR^(a)R^(b) or NR^(a)R^(b), (where R^(a)and R^(b) are as above defined); phenyl(C₁₋₄alkyl), (optionally substituted by one or more of C₁₋₆ alkyl, C₁₋₆ alkoxy, halo and trifluoromethyl in the phenyl ring); C₂₋₆ alkylene; COR^(a); COOR^(a); CONHR^(a); COC₁₋₆alkylhalo; COC₁₋₆alkylNR^(a)R^(b); or CONR^(a)C₁₋₆alkylCONR^(a)R^(b), where R^(a)and R^(b) are as previously defined;

or R¹ and R² together form a chain (CH₂)_(p) optionally substituted by oxo; where p is 4 or 5 and where one methylene group may optionally be replaced by an oxygen atom or a group NR^(x), where R^(x) is H or C₁₋₆ alkyl;

R³ represents H or C₁₋₆alkyl;

R⁴ represents H, C₁₋₆ alkyl or phenyl (optionally substituted by one or more of C₁₋₆ alkyl, C₂₋₆ alkenyl, C₂₋₆ alkynyl, halo, cyano, nitro, trifluoromethyl, trimethylsilyl, SR^(c), SOR^(c), SO₂R^(c), OR^(c), NR^(c)R^(d), NR^(c)COR^(d), NR^(c)COOR^(d), COOR^(c) or CONR^(c)R^(d), where R^(c) and R^(d)each independently represent H, C₁₋₆alkyl, phenyl or trifluoromethyl); and

R⁵ represents (CH₂)_(q)phenyl, wherein q is 0, 1, 2 or 3, which may optionally be substituted in the phenyl ring by one or more of C₁₋₆ alkyl, C₂₋₆ alkenyl, C₂₋₆ alkynyl, halo, cyano, nitro, trifluoromethyl, trimethylsilyl, SR^(c), SOR^(c), SO₂R^(c), OR^(c), NR^(c)R^(d), NR^(c)COR^(d), NR^(c)COOR^(d), COOR^(c) or CONR^(c)R^(d), where R^(c) and R^(d) are as above defined.

WO 93/01169, i.e. compounds of the formula (R) or a salt or prodrug thereof

wherein

q represents optionally substituted phenyl, optionally substituted naphthyl, optionally substituted indolyi, optionally substituted benzthiophenyl, optionally substituted benzofuranyl, optionally substituted benzyl or optionally substituted indazolyl;

z represents O, S or NR⁸, where R⁸ is H or C₁₋₆alkyl;

X and Y each represent H or X and Y together form a group ═O;

R¹ and R² each independently represent H; C₁₋₆alkyl, optionally substituted by hydroxy, cyano, COR^(c), CO₂R^(c), CONR^(c)R^(d), or NR^(c)R^(d)(where R^(c)and R^(d)each independently represent H, C₁₋₁₂alkyl or phenyl optionally substituted by one or more of C₁₋₆alkyl, C₁₋₆alkoxy, halo or trifluoromethyl); phenyl(C₁₋₄alkyl) (optionally substituted in the phenyl ring by one or more of C₁₋₆alkyl, C₁₋₆alkoxy, halo and trifluoromethyl); COR^(c); CO₂R^(c); CONR^(c)R^(d); CONR^(c)COOR^(d); or SO₂R^(c), where R^(c)and R^(d)are as above defined;

R³ represents H or C₁₋₆Ialkyl; and

R⁴ represents H, C₁₋₆alkyl or phenyl (optionally substituted by 1, 2 or 3 groups selected from C₁₋₆alkyl, C₂₋₆alkenyl, C₂₋₆alkynyl, halo, cyano, nitro trifluoromethyl, trimethylsilyl, OR^(a), SR^(a), SOR^(a), NR^(a)R^(b), NR^(a)COR^(b), NR^(a)CO₂R^(b); CO₂R^(a)or CONR^(a)R^(b), where R^(a)and R^(b) independently represent H, C₁₋₆alkyl, phenyl or trifluoromethyl); and

R⁵ represents phenyl (optionally substituted by 1, 2 or 3 groups selected from C₁₋₆alkyl, C₂₋₆alkenyl, C₂₋₆alkynyl, halo, cyano, nitro, trifluoromethyl, trimethylsilyl, OR^(a), SR^(a), SOR^(a), NR^(a)R^(b), NR^(a)COR^(b), NR^(a)CO₂R^(b), CO₂R^(a) or CONR^(a)R^(b), where R^(a)and R^(b) independently represent H, C₁₋₆alkyl, phenyl or trifluoromethyl); with the exception of benzyl 3-(3-indolyl)-2-amino propionate;

4-nitrobenzyl 3-(3-indolyl)-2-aminopropionate;

4-nitrobenzyl 2-(1,1-dimethylethoxycarbonylamino)-3-(3-indolyl) propionate;

benzyl 2-(1,1 imethylethoxycarbonylamino)-3-(3-indolyl)propionate;

4-methoxybenzyl 2-(1,1-dimethylethoxycarbonylamino)-3-(3-indolyl)propionate;

2,4,6-trimethylbenzyl 3-(3-indolyl)-2-aminopropionate; benzyl 3-(3-indolyl)-2-((4-methylphenyl) sulphonamido)propionate;

benzyl 2-(1,1-dimethylpropyloxycarbonylamino)-3-(3-indolyl)propionate;

4-nitrobenzyl 2-acetamido-3-(3-indolyl)propionate; benzyl 3-(1-naphthyl)-2-aminopropionate;

benzyl 3-(1-naphthyl)-2-(1,1-dimethylethoxycarbonyl amino)propionate;

benzyl 3-(2-naphthyl)-2-aminopropionate;

N-methyl-N-benzyl 3-(2-naphthyl)-2-(1,1-dimethylethoxycarbonylamino)propionamide;

N-methyl-N-(4-fluorobenzyl)-3-(2-naphthyl)-2-(1,1-dimethylethoxycarbonylamino)propionamide;

N-methyl-N-(2-fluorobenzyl)-3-(2-naphthyl)-2-(1,1-dimethylethoxycarbonylamino)propionamide;

N-methyl-N-benzyl-3-(1-naphthyl)-2-(1,1-dimethylethoxycarbonylamino)propionamide;

N-methyl-N-(4-fluorobenzyl)-3-(2-naphthyl)-2-aminopropionamide;

N-methyl-N-(3-fluorobenzyl)-3-(2-naphthyl)-2-aminopropionamide;

N-methyl-N-(3-fluorobenzyl)-3-(2-naphthyl)-2-aminopropionamide,

N-methyl-N-benzyl-3-(2-naphthyl)-2-aminopropionamide;

N-methyl-N-(3-fluorobenzyl)-3-(2-naphthyl)-2-(1,1-dimethylethoxycarbonylamino)propionamide;

benzyl 3-phenyl-2-aminopropionate; and

4-nitrobenzyl 3-phenyl-2-aminopropionate.

WO 93/01170; i.e. compounds of the formula (S)

wherein Y is (CH₂)_(n) wherein n is an integer from 1 to 6, and wherein any one of the carbon-carbon single bonds in said (CH₂)_(n) may optionally be replaced by a carbon-carbon double bond, and wherein any one of the carbon atoms of said (CH₂)_(n) may optionally be substituted with R⁴, and wherein any one of the carbon atoms of said (CH₂)_(n) may optionally be substituted with R⁷;

m is an integer from 0 to 8, and any one of the carbon-carbon single bonds of (CH₂)_(m) may optionally be replaced by a carbon-arbon double bond or a carbon-carbon triple bond, and any one of the carbon atoms of said (CH₂)_(m) may be optionally substituted with R⁸,

R¹ is hydrogen or (C₁-C₈) alkyl optionally substituted with hydroxy, alkoxy or fluoro;

R² is a radical selected from hydrogen, (C₁-C₆) straight or branched alkyl, (C₃-C₇)cycloalkyl wherein one of the carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur, aryl selected from phenyl and naphthyl; heteroaryl selected from indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; phenyl (C₂-C₆) alkyl, benzhydryl and benzyl, wherein each of said aryl and heteroaryl groups and the phenyl moieties of said benzyl, phenyl (C₂-C₆) alkyl and benzhydryl may optionally be substituted with one or more substituents independently selected from halo, nitro, (C₁-C₆)alkyl, (C₁-C₆) alkoxy, trifluoromethyl, amino, (C₁-C₆)alkylamino, (C₁-C₆)alkyl-O—C(O)—, (C₁-C₆)alkyl-O—C(O)—, (C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—O—, (C₁-C₆)alkyl-C(O)—(C₁-C₆)alkyl-O—, (C₁-C₆)alkylC(O)—, (C₁-C₆)alkyl-C(O)—(C₁-C₆)alkyl-, di-(C₁-C₆)alkylamino, —C(O)NH(C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—NH—(C₁-C₆)alkyl, —NH(O)CH and —NH(O)C(C₁-C₆)alkyl; and wherein one of the phenyl moieties of said benzhydryl may optionally be replaced by naphthyl, thienyl, furyl or pyridyl;

R⁵ is hydrogen, phenyl or (C₁-C₆)alkyl;

or R² and R⁵, together with the carbon to which they are attached, form a saturated carbocyclic ring having from 3 to 7 carbon atoms wherein one of said carbon atoms may optionally be replaced by oxygen, nitrogen or sulfur;

R³ is aryl selected from phenyl and naphthyl; heteroaryl selected from indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; and cycloalkyl having 3 to 7 carbon atoms wherein one of said carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said (C₃-C₇) cycloalkyl may optionally be substituted with one or two substituents, each of said substituents being independently selected from halo, nitro, (C₁-C₆) alkyl, (C₁-C₆) alkoxy, trifluoromethyl, phenyl, amino, (C₁-C₆)alkylamino, -C(O)—NH—(C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—NH—(C₁-C₆)alkyl, —NHC(O)H and —NHC(O)—(C₁-C₆)alkyl; and

R⁴ and R⁷ are each independently selected from hydrogen, hydroxy, halo, amino, oxo (═O), nitrile, (C₁-C₆)alkylamino, di-(C₁-C₆)alkylamino, (C₁-C₆)alkoxy, (C₁-C₆)alkyl-O—C(O)—, (C₁-C₆)alkyl-O—C(O)—(C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—O—, (C₁-C₆)alkyl-C(O)—(C₁-C₆)alkyl-O—, hydroxy-(C₁-C₆)alkyl, (C₁-C₆)alkoxy(C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—, (C₁-C₆)alkyl-C(O)—C₁-C₆)alkyl- and the radicals set forth in the definition of R²,

R⁶ is NHC(O)R⁹, NHCH₂R⁹, SO₂R⁹ or one of the radicals set forth in any of the definitions of R², R⁴ and R⁷;

R⁸ is oximino (═NOH) or one of the radicals set forth in any of the definitions of

R², R⁴ and R⁷;

R⁹ is (C₁-C₆)alkyl, hydrogen, phenyl or phenyl (C₁-C₆)alkyl;

with the proviso that (a) when m is O, R⁸ is absent, (b) neither R⁴, R⁶, R⁷ nor R⁸ can form, together with the carbon to which it is attached, a ring with R⁵, (c) when R⁴ and R⁷ are attached to the same carbon atom, then either each of R⁴, and R⁷ is independently selected from hydrogen, fluoro and (C₁-C₆) alkyl, or R⁴ and R⁷, together with the carbon to which they are attached, form a (C₃-C₆) saturated carbocyclic ring that forms a spiro compound with the nitrogencontaining ring to which they are attached, (d) when n is 2 and either R⁴ or R⁷ is 5-hydroxy(C₁-C₆)alkyl or 5-(C₁-C₆)alkoxy-(C₁-C₆)alkyl, then the other of R⁴ and R⁷ is hydrogen, (e) when n is 2, neither R⁴ nor R⁷ is 4-hydroxy(C₁₋₆)alkyl or 4-(C₁-C₆)alkoxy (C₁-C₆)alkyl, and (f) in all compounds of the formula (s), either R³ is aryl substituted with at least one phenyl group, or one or both of R⁴ and R⁷ is hydroxy-(C₁-C₆)alkyl or (C₁-C₆)alkoxy(C₁-C₆)alkyl.

For example

(2S,3S)-3-(5-carbomethoxy-2-methoxybenzyl)amino-2-phenylpiperidine hydrochloride-Compound 4;

Preferred tachykinin antagonists for use in the present invention include those compounds generically and specifically disclosed in EP 522808, WO 92/17449, WO 93100331, WO 93101170 and EP528495.

The tachykinin antagonists may be administered as the raw chemical but the active ingredients are preferably presented as a pharmaceutical formulation. Suitable pharmaceutical formulations are described in the above referenced patent specifications.

Thus, the tachykinin antagonists may be formulated for oral, buccal, parenteral, depot or rectal administration or in a form suitable for administration by inhalation or insufflation (either through the mouth or nose). Oral and parenteral formulations are preferred.

For oral administration, the pharmaceutical compositions may take the form of, for example, tablets or capsules prepared by conventional means with pharmaceutically acceptable excipients such as binding agents (e.g. pregelatinised maize starch, polyvinylpyrrolidone or hydroxypropyl methylcellulose); fillers (e.g. lactose, microcrystalline cellulose or calcium hydrogen phosphate); lubricants (e.g. magnesium stearate, talc or silica); disintegrants (e.g. potato starch or sodium starch glycollate); or wetting agents (e.g. sodium lauryl sulphate). The tablets may be coated by methods well known in the art. Liquid preparations for oral administration may take the form of, for example, solutions, syrups or suspensions, or they may be presented as a dry product for constitution with water or other suitable vehicle before use. Such liquid preparations may be prepared by conventional means with pharmaceutically acceptable additives such as suspending agents (e.g. sorbitol syrup, cellulose derivatives or hydrogenated edible fats); emulsifying agents (e.g. lecithin or acacia); non-aqueous vehicles (e.g. almond oil, oily esters, ethyl alcohol or fractionated vegetable oils); and preservatives (e.g. methyl or propylp-hydroxybenzoates or sorbic acid). The preparations may also contain buffer salts, flavouring, colouring and sweetening agents as appropriate.

Preparations for oral administration may be suitably formulated to give controlled release of the active compound.

For buccal administration the composition may take the form of tablets or lozenges formulated in conventional manner.

The tachykinin antagonists may be formulated for parenteral administration by bolus injection or continuous infusion. Formulations for injection may be presented in unit dosage form e.g. in ampoules or in multi-dose containers, with an added preservative. The compositions may take such forms as suspensions, solutions or emulsions in oily or aqueous vehicles, and may contain formulatory agents such as suspending, stabilising and/or dispersing agents. Alternatively, the active ingredient may be in powder form for constitution with a suitable vehicle, e.g. sterile pyrogen-free water, before use.

The tachykinin antagonists may also be formulated in rectal compositions such as suppositories or retention enemas, e.g. containing conventional suppository bases such as cocoa butter or other glycerides.

The tachykinin antagonists may also be formulated as depot preparations. Such long acting formulations may be administered by implantation (for example subcutaneously or intramuscularly) or by intramuscular injection. Thus, for example, the compounds of the invention may be formulated with suitable polymeric or hydrophobic materials (for example as an emulsion in an acceptable oil) or ion exchange resins, or as sparingly soluble derivatives, for example, as a sparingly soluble salt.

For intranasal administration, the tachykinin antagonists may be formulated as solutions for administration via a suitable metered or unit dose device or alternatively as a powder mix with a suitable carrier for administration using a suitable delivery device.

Suitable dose ranges are also described in the above referenced patent specifications, that is to say that for use as anti-emetics the compounds may be used at doses appropriate for other conditions for which tachykinin antagonists are known to be useful. It will be appreciated that it may be necessary to make routine variations to the dosage, depending on the age and condition of the patient, and the precise dosage will be ultimately at the discretion of the attendant physician or veterinarian. The dosage will also depend on the route of administration and the particular compound selected. A suitable dose range is for example 0.1 mg/kg to about 400 mgtkg bodyweight per day.

The tachykinin antagonists may, if desired, be administered in combination with one or more other therapeutic agents and formulated for administration by any convenient route in a conventional manner. Appropriate doses will be readily appreciated by those skilled in the art. For example, the tachykinin antagonists may be administered in combination with a systemic anti-inflammatory corticosteroid such as methyl prednisolone or dexamethasone, or a 5HT₃ antagonist such as ondansetron, granisetron or metoclopramide.

Biological Data

The anti-emetic activity of the test compounds 1, 2 (as hydrochloride salt), 3, 4 and 5 (as racemates) and 6 (as single enantiomer) defined hereinbefore was demonstrated by their ability to inhibit cisplatin- or radiation-induced emesis in the ferret.

Cisplatin Test

In this model of emesis the onset of retching and vomiting occurs approximately 1 hour after the administration of cisplatin (200 mg/m² i.p.). At first retch in response to cisplatin, the test compound was administered (e.g. i.p., p.o., i.v., s.c., i.c.v.) and its effect on emesis determined by comparison with appropriate controls (e.g. water).

Radiation Test

In this model of emesis the onset of retching and vomiting occurs approximately 20 minutes after whole body irradiation (2 Grey=200 Rads). The test compound is administered (e.g. i.p., p.o., i.v., s.c.) immediately after irradiation and its effect on emesis determined by comparison with appropriate controls. In the case of compound 6, this test compound was administered 90 minutes before whole body irradiation.

Test compounds 1 to 6 inhibited emesis in the above tests at the doses shown:

Compound Dose mg/kg Test 1 10 (i.p.) cisplatin 2 1.0 (s.c.)  radiation 3 10 (s.c.) cisplatin 4 10 (s.c.) cisplatin 5 10 (s.c) cisplatin 6 0.03 (s.c)   radiation

REFERENCE EXAMPLE

The compound (2S,3S)-3-(2-methoxybenzylamino)-2-phenyl piperidine inhibited cisplatin-induced emesis in the ferret when administered at a dose of 3 mg/kg i.p. The (2R, 3R) enantiomer of the above compound, which is 1000-fold less active as an NK₁ receptor antagonist than the (2S,3S) enantiomer, was inactive in the cisplatin emesis test at the same dose. 

What is claimed is:
 1. A pharmaceutical composition for the treatment of emesis, comprising: an effective amount of an NK₁ receptor antagonist of formula J, N, S or G:

wherein R¹ is aryl selected from the group consisting of indanyl, phenyl and naphthyl; heteroaryl selected from the group consisting of thienyl, furyl, pyridyl and quinolyl; or cycloalkyl having 3 to 7 carbon atoms, wherein one of said carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said (C₃-C₇)cycloalkyl may optionally be substituted with one or two substituents, said substituents being independently selected from the group consisting of chloro, fluoro, bromo, iodo, nitro, (C₁-C₁₀)alkyl optionally substituted with from one to three fluoro groups, (C₁-C₁₀)alkoxy optionally substituted with from one to three fluoro groups, amino, (C₁-C₁₀)alkyl-S—, (C₁-C₁₀)alkyl-S(O)—, (C₁-C₁₀)alkyl-SO₂—, phenyl, phenoxy, (C₁-C₁₀)alkyl-SO₂NH—, (C₁-C₁₀)alkyl-SO₂NH—(C₁-C₁₀)alkyl-, (C₁-C₁₀)alkylamino-di(C₁-C₁₀)alkyl-, cyano, hydroxy, cycloalkoxy having 3 to 7 carbon atoms, (C₁-C₆)alkylamino, (C₁-C₆)dialkylamino, HC(O)NH— and (C₁-C₁₀)alkyl-C(O)—NH—, wherein the nitrogen atoms of said amino and (C₁-C₆)alkylamino groups may optionally be protected with an appropriate protecting group; and R² is thienyl, benzhydryl, naphthyl or phenyl optionally substituted with from one to three substituents independently selected from the group consisting of chloro, bromo, fluoro, iodo, cycloalkoxy having 3 to 7 carbon atoms, (C₁-C₁₀)alkyl optionally substituted with from one to three fluoro groups, and (C₁-C₁₀)alkoxy optionally substituted with from one to three fluoro groups;

wherein X¹ is hydrogen, (C₁-C₁₀)alkoxy optionally substituted with from one to three fluorine atoms or (C₁-C₁₀)alkyl optionally substituted with from one to three fluorine atoms; X² and X³ are independently selected from the group consisting of hydrogen, halo, nitro, (C₁-C₁₀)alkyl optionally substituted with from one to three fluorine atoms, (C₁-C₁₀)alkoxy optionally substituted with from one to three fluorine atoms, trifluoromethyl, hydroxy, phenyl, cyano, amino, C₁-C₆)-alkylamino, di-(C₁-C₆)alkylamino, —C(O)—NH—(C₁-C₆)-alkyl, (C₁-C₆)alkyl-C(O)—NH—C₁-C₆)alkyl, hydroxy, (C₁-C₄)alkyl, (C₁-C₄)alkyoxy(C₁-C₄)alkyl, —NH—C(O)H and —NHC(O)—(C₁-C₆)alkyl; and Q is a group of the formula

wherein R¹ is a radical selected from the group consisting of furyl, thienyl, pyridyl, indolyl, biphenyl and phenyl optionally substituted with one or two substituents independently selected from the group consisting of halo, (C₁-C₁₀)alkyl optionally substituted with from one to three fluorine atoms, (C₁-C₁₀)alkoxy optionally substituted with from one to three fluorine atoms, carboxy, benzyloxycarbonyl and (C₁-C₃)alkoxy-carbonyl; R¹³ is selected from the group consisting of (C₃-C₄) branched alkyl, (C₅-C₆) branched alkenyl, (C₅-C₇)cycloalkyl, and the radicals named in the definition of R¹; R² is hydrogen or (C₁-C₆)alkyl; R³ is phenyl, biphenyl, naphthyl, pyridyl, benzhydryl, thienyl or furyl, and R³ may optionally be substituted with from one to three substituents independently selected from the group consisting of halo, (C₁-C₁₀)alkyl optionally substituted with from one to three fluorine atoms and (C₁-C₁₀)alkoxy optionally substituted with from one to three fluorine atoms; Y is (CH₂)_(l) wherein l is an integer from one to three or Y is a group of the formula

Z is oxygen, sulfur, amino, (C₁-C₃)alkylamino or (CH₂)_(n) wherein n is zero, one or two; o is two or three; p is zero or one; R⁴ is furyl, thienyl, pyridyl, indolyl, biphenyl, or phenyl optionally substituted with one or two substituents independently selected from the group consisting of halo, (C₁-C₁₀)alkyl optionally substituted with from one to three fluorine atoms, (C₁-C₁₀)alkoxy optionally substituted with from one to three fluorine atoms, carboxy, (C₁-C₃)alkoxycarbonyl and benzyloxycarbonyl; R⁵ is thienyl, biphenyl or phenyl optionally substituted with one or two substituents independently selected from the group consisting of halo, (C₁-C₁₀)alkyl optionally substituted with from one to three fluorine atoms and (C₁-C₁₀)alkoxy optionally substituted with from one to three fluorine atoms; each of the two dashed lines in formula (N) and the dashed line in formula (II) represents an optional double bond that may optionally exist when Q is a group of the formula (II); X is (CH₂)_(q) wherein q is an integer from 1 to 6, and wherein any one of the carbon-carbon single bonds in said (CH₂)_(q) may optionally be replaced by a carbon-carbon double bond, and wherein any one of the carbon atoms of said (CH₂)_(q) may optionally be substituted with R⁸, and wherein any one of the carbon atoms of said (CH₂)_(q) may be substituted with R⁹; m is an integer from 0 to 8, and any one of the carbon-carbon single bonds of (CH₂)_(m) may optionally be replaced by a carbon-carbon double bond, or a carbon-carbon triple bond, and any one of the carbon atoms of (CH₂)_(m) may optionally be substituted with R¹¹; R⁶ is a radical selected from the group consisting of hydrogen, (C₁-C₆) straight or branched alkyl, (C₃-C₇) cycloalkyl wherein one of the carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; aryl selected from the group consisting of biphenyl, phenyl, indanyl and naphthyl; heteroaryl selected from the group consisting of thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; phenyl(C₂-C₆)alkyl, benzhydryl and benzyl, wherein each of said aryl and heteroaryl groups and the phenyl moieties of said benzyl, phenyl(C₂-C₆)alkyl and benzhydryl may optionally be substituted with one or more substituents independently selected from the group consisting of halo, nitro, (C₁-C₁₀)alkyl optionally substituted with from one to three fluorine atoms, (C₁-C₁₀)alkoxy optionally substituted with from one to three fluorine atoms, amino, hydroxy-(C₁-C₆)alkyl, (C₁-C₆)alkoxy-(C₁-C₆)alkyl, (C₁-C₆)alkylamino, (C₁-C₆)alkyl-O—C(O)—, (C₁-C₆)alkyl-O—C(O)—C—(C₁-C₆)alkyl, (C₁-C₆)alkyl-C—(O)—(O)—, (C₁-C₆)alkyl-C(O)(C₁-C₆)alkyl-O—, (C₁-C₆)alkyl-C(O), (C₁-C₆)alkyl-C(O)C₁-C₆)alkyl-, di-(C₁-C₆)alkylamino, —C(O)NH—(C₁-C₆)-alkyl-, (C₁-C₆)alkyl-C(O)—NH—(C₁-C₆)alkyl, —NHC(O)H and NHC(O)—(C₁-C₆)alkyl; and wherein one of the phenyl moieties of said benzhydryl may optionally be replaced by naphthyl, thienyl, furyl or pyridyl; R⁷ is hydrogen, phenyl or (C₁-C₆)alkyl; or R⁶ and R⁷, together with the carbon to which they are attached, form a saturated carbocyclic ring having from 3 to 7 carbon atoms wherein one of said carbon atoms may optionally be replaced by oxygen, nitrogen or sulfur; R⁸ and R⁹ are each independently selected from the group consisting of hydrogen, hydroxy, halo, amino, oxo (═O), nitrile, hydroxy-(C₁-C₆)alkyl, (C₁-C₆)-alkoxy-(C₁-C₆)alkyl, (C₁-C₆)alkylamino, di-(C₁-C₆)alkylamino, (C₁-C₆)alkoxy, (C₁-C₆)alkyl-O—C(O)—, (C₁-C₆)alkyl-O—C(O)—(C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—O, (C₁-C₆)alkyl-C(O)—(C₁-C₆)alkyl-O—, (C₁-C₆)alkyl-C(O)—, (C₁-C₆)alkyl-C(O)—(C₁-C₆) alkyl-, and the radicals set forth in the definition of R⁶; R¹⁰ is NHCR¹², NHCH₂R¹², NHSO₂R¹², or one of the radicals set forth in any of the definitions of R⁶, R⁸ and R⁹; R¹¹ is oximino (═NOH) or one of the radicals set forth in any of the definitions of R⁶, R⁸ and R⁹; and R¹² is (C₁-C₆)alkyl, hydrogen, phenyl(C₁-C₆)alkyl or phenyl optionally substituted with (C₁-C₆)alkyl, and with the provisos that (a) when m is O, R¹¹ is absent; (b) neither R⁸, R⁹, R¹⁰ nor R¹¹ can form, together with the carbon to which it is attached, a ring with R⁷; (c) when Q is a group of the formula (VIII), R⁸ and R⁹ cannot be attached to the same carbon atom; (d) when R⁸ and R⁹ are attached to the same carbon atom, then either each of R⁸ and R⁹ is independently selected from hydrogen, fluoro, (C₁-C₆)alkyl, hydroxy-(C₁-C₆)alkyl and (C₁-C₆)alkoxy-(C₁-C₆)alkyl, R⁸ and R⁹, together with the carbon to which they are attached, form a (C₃-C₆) saturated carbocyclic ring that forms a spiro compound with the nitrogen-containing ring to which they are attached; (e) the nitrogen of formula (N) cannot be double bonded to both Q and the substituted benzyl group to which it is attached; (f) when Q is a group of the formula (VII) and q is 2 and either R⁸ or R⁹ is 5-hydroxy-(C₁-C₆)alkyl or 5-(C₁-C₆)alkoxy-(C₁-C₆)alkyl, then the other of R⁸ or R⁹ is either 5-(C₁-C₆)alkyl or hydrogen; (g) when Q is a group of the formula (VII) and q is 2, then neither R⁸ or R⁹ is 4-hydroxy-(C₁-C₆)alkyl or 4-(C₁-C₆)alkoxy-(C₁-C₆)alkyl; and (h) when neither X¹, X² nor X³ is a fluorinated alkoxy group, at least one of R¹, R³, R⁴, R⁵, R⁶, R⁷ and R¹³ is an aryl group substituted with a fluorinated alkoxy group; and pharmaceutically acceptable acid addition and base salts of compounds of the formula (N);

wherein Y is (CH₂)_(n) wherein n is an integer from 1 to 6, and wherein any one of the carbon-carbon single bonds in said (CH₂)_(n) may optionally be replaced by a carbon-carbon double bond, and wherein any one of the carbon atoms of said (CH₂)_(n) may optionally be substituted with R⁴, and wherein any one of the carbon atoms of said (CH₂)_(n) may be substituted with R⁷; m is an integer from 0 to 8, and any one of the carbon-carbon single bonds of (CH₂)_(m) may optionally be replaced by a carbon-carbon double bond, or a carbon-carbon triple bond, and any one of the carbon atoms of said (CH₂)_(m) may be optionally substituted with R⁸; R¹ is hydrogen or (C₁-C₈)alkyl optionally substituted with hydroxy, alkoxy or fluoro; R² is a radical selected from the group consisting of hydrogen, (C₁-C₆) straight or branched alkyl, (C₃-C₇)cycloalkyl wherein one of the carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; aryl selected from the group consisting of phenyl and naphthyl; heteroaryl selected from the group consisting of indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, triazolyl, tetrazolyl and quinolyl; phenyl(C₂-C₆)alkyl, benzhydryl and benzyl, wherein each of said aryl and heteroaryl groups and the phenyl moieties of said benzyl, phenyl(C₂-C₆)alkyl and benzhydryl may optionally be substituted with one or more substituents independently selected from halo, nitro, (C₁-C₆)alkyl, (C₁-C₆)alkoxy, trifluoromethyl, amino, (C₁-C₆)alkylamino, (C₁-C₆)alkyl-O—C—(O)—, (C₁-C₆)alkyl-O—C(O)—(C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—O, (C₁-C₆)alkyl-C(O)(C₁-C₆)alkyl-O—, (C₁-C₆)alkyl-C(O)—, (C₁-C₆)alkyl-C(O)—(C₁-C₆)alkyl-, di-(C₁-C₆)alkylamino, —C(O)NH—(C₁-C₆)alkyl-, (C₁-C₆)alkyl-C(O)—NH—(C₁-C₆)alkyl, —NH(O)CH and —NH(O)C-(C₁-C₆) alkyl; and wherein one of the phenyl moieties of said benzhydryl may optionally be replaced by naphthyl, thienyl, furyl or pyridyl; R⁵ is hydrogen, phenyl or (C₁-C₆)alkyl; or R² and R⁵, together with the carbon to which they are attached, form a saturated carbocyclic ring having from 3 to 7 carbon atoms wherein one of said carbon atoms may optionally be replaced by oxygen, nitrogen or sulfur; R³ is aryl selected from the group consisting of phenyl and naphthyl; heteroaryl selected from the group consisting of indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; and cycloalkyl having 3 to 7 carbon atoms wherein one of said carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said (C₃-C₇)cycloalkyl may optionally be substituted with one or two substituents, each of said substituents being independently selected from the group consisting of halo, nitro, (C₁-C₆)alkyl, (C₁-C₆)alkoxy, trifluoromethyl, phenyl, amino, (C₁-C₆)alkylamino, —C(O)NH—(C₁-C₆)alkyl, (C₁-C₆)alkyl C(O)—NH-(C₁-C₆)alkyl, —NHC(O)H and —NHC(O)—(C₁-C₆)alkyl; R⁴ and R⁷ are each independently selected from the group consisting of hydrogen, hydroxy, halo, amino, oxo (═O), nitrile, (C₁-C₆)alkylamino, di-(C₁-C₆)alkylamino, (C₁-C₆)alkoxy, (C₁-C₆)alkyl-O—C(O)—, (C₁-C₆)alkyl-O—C(O)-(C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—O, (C₁-C₆)alkyl-C(O)-(C₁-C₆)alkyl-O, hydroxy-(C₁-C₆)alkyl, (C₁-C₆)alkoxy(C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—, (C₁-C₆)alkyl-C(O)-(C₁-C₆)alkyl- and the radicals set forth in the definition of R²; R⁶is NHC(O)R⁹, NHCH₂R⁹, SO₂R⁹, or one of the radicals set forth in any of the definitions of R², R⁴ and R⁷; R⁸ is oximino (═NOH) or one of the radicals set forth in any of the definitions of R², R⁴ and R⁷; R⁹ is (C₁-C₆)alkyl, hydrogen, phenyl or phenyl(C₁-C₆)alkyl; with the provisos that (a) when m is O, R⁸ is absent; (b) neither R⁴, R⁶, R⁷ nor R⁸ can form, together with the carbon to which it is attached, a ring with R⁵; (c) when R⁴ and R⁷ are attached to the same carbon atom, then either each of R⁴ and R⁷ is independently hydrogen, fluoro or (C₁-C₆)alkyl, or R¹ and R⁷, together with the carbon to which they are attached, form a (C₃-C₆) saturated carbocyclic ring that forms a spiro compound with the nitrogen-containing ring to which they are attached; (d) when n is 2 and either R⁴ or R⁷ is 5-hydroxy(C₁-C₆)alkyl or 5-(C₁-C₆)alkoxy-C₁-C₆)alkyl, then the other of R⁴ and R⁷ is hydrogen; (e) when n is 2, neither R⁴ nor R⁷ is 4-hydroxy(C₁-C₆)alkyl or 4-(C₁-C₆)alkoxy(C₁-C₆)alkyl; and (f) in all compounds of the formula (S), either R³ is aryl substituted with at least one phenyl group, or one or both of R⁴ and R⁷ is hydroxy-(C₁-C₆)alkyl or (C₁-C₆)alkoxy(C₁-C₆)alkyl;

wherein n is 1, 2 or 3 and where any carbon atom of (CH₂)_(n) may be substituted by R⁴ and/or R⁵; X represents O or S; R¹ represents phenyl optionally substituted by 1, 2 or 3 groups selected from the group consisting of C₁₋₆ alkyl, C₂₋₆ alkenyl; C₂₋₆ alkynyl, halo, cyano, nitro, trifluoromethyl, trimethylsilyl, —OR^(a), SR^(a), SOR^(a), SO₂R^(a), —NR^(a)R^(b), —NR^(a)COR^(b), —NR^(a)CO₂R^(b), CO₂R^(a), or —CONR^(a)R^(b); R² represents aryl selected from the group consisting of phenyl and naphthyl; heteroaryl selected from the group consisting of indazolyl, thienyl, furyl, pyridyl, thiazolyl, tetrazolyl and quinolyl; benzhydryl; or benzyl; wherein each aryl or heteroaryl moiety may be substituted by C₁₋₆ alkyl, C₁₋₆ alkoxy, halo or trifluoromethyl; R⁴ and R⁵ each independently represent H, halo, CH₂OR⁹, C₁₋₆ alkyl, oxo, CO₂R¹⁰ or CONR¹⁰R¹¹; R⁸ represents H, COR⁹, CO₂R¹⁰, COCONR¹⁰R¹¹, COCO₂R¹⁰ or C₁₋₆ alkyl optionally substituted by a group selected from the group consisting of CO₂R¹⁰, CONR¹⁰R¹¹, hydroxy, cyano, COR⁹, NR¹⁰R¹¹, C(NOH)NR¹⁰R¹¹, CONHphenyl-(C₁₋₄alkyl), COCO₂R¹⁰, COCONR¹⁰R¹¹ and phenyl optionally substituted by one or more substituents selected from the group consisting of C₁₋₆alkyl, C₁₋₆alkoxy, halo and trifluoromethyl; R^(a) and R^(b) each independently represent H, C₁₋₆alkyl, phenyl or trifluoromethyl; R⁹ represents H, C₁₋₆alkyl or phenyl; and R¹⁰ and R¹¹ each independently represent H or C₁₋₆alkyl; in combination with an effective amount of a 5HT₃ antagonist which is selected from the group consisting of ondansetron, granisetron and metoclopramide.
 2. A pharmaceutical composition for the treatment of emesis, comprising: an effective amount of an NK₁ antagonist which is (2S,3S)-2-phenyl-3-(2-trifluoromethoxybenzyl)aminopiperidine; and an effective amount of a 5HT₃ antagonist which is ondansetron.
 3. A method for the treatment of emesis in a mammal, comprising: administering to said mammal an effective amount of an NK₁ receptor antagonist of formula J, N, S or G:

wherein R¹ is aryl selected from the group consisting of indanyl, phenyl and naphthyl; heteroaryl selected from the group consisting of thienyl, furyl, pyridyl and quinolyl; or cycloalkyl having 3 to 7 carbon atoms, wherein one of said carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said (C₃-C₇)cycloalkyl may optionally be substituted with one or two substituents, said substituents being independently selected from the group consisting of chloro, fluoro, bromo, iodo, nitro, (C₁-C₁₀)alkyl optionally substituted with from one to three fluoro groups, (C₁-C₁₀)alkoxy optionally substituted with from one to three fluoro groups, amino, (C₁-C₁₀)alkyl-S—, (C₁-C₁₀)alkyl-S(O)—, (C₁-C₁₀)alkyl-SO₂—, phenyl, phenoxy, (C₁-C₁₀)alkyl-SO₂NH—, (C₁-C₁₀)alkyl-SO₂NH—(C₁-C₁₀)alkyl-, (C₁-C₁₀)alkylamino-di(C₁-C₁₀)alkyl-, cyano, hydroxy, cycloalkoxy having 3 to 7 carbon atoms, (C₁-C₆)alkylamino, (C₁-C₆)dialkylamino, HC(O)NH— and (C₁-C₁₀)alkyl-C(O)—NH—, wherein the nitrogen atoms of said amino and (C₁-C₆)alkylamino groups may optionally be protected with an appropriate protecting group; and R² is thienyl, benzhydryl, naphthyl or phenyl optionally substituted with from one to three substituents independently selected from the group consisting of chloro, bromo, fluoro, iodo, cycloalkoxy having 3 to 7 carbon atoms, (C₁-C₁₀)alkyl optionally substituted with from one to three fluoro groups, and (C₁-C₁₀)alkoxy optionally substituted with from one to three fluoro groups;

wherein X¹ is hydrogen, (C₁-C₁₀)alkoxy optionally substituted with from one to three fluorine atoms or (C₁-C₁₀)alkyl optionally substituted with from one to three fluorine atoms; X² and X³ are independently selected from the group consisting of hydrogen, halo, nitro, (C₁-C₁₀)alkyl optionally substituted with from one to three fluorine atoms, (C₁-C₁₀)alkoxy optionally substituted with from one to three fluorine atoms, trifluoromethyl, hydroxy, phenyl, cyano, amino, (C₁-C₆)-alkylamino, di-(C₁-C₆)alkylamino, —C(O)—NH-(C₁-C₆)-alkyl, (C₁-C₆)alkyl-C(O)—NH-(C₁-C₆)alkyl, hydroxy, (C₁-C₄)alkyl, (C₁-C₄)alkyoxy (C₁-C₄)alkyl, —NH—C(O)H and —NHC(O)-(C₁-C₆)alkyl; and Q is a group of the formula

wherein R¹ is a radical selected from the group consisting of furyl, thienyl, pyridyl, indolyl, biphenyl and phenyl optionally substituted with one or two substituents independently selected from the group consisting of halo, (C₁-C₁₀)alkyl optionally substituted with from one to three fluorine atoms, (C₁-C₁₀)alkoxy optionally substituted with from one to three fluorine atoms, carboxy, benzyloxycarbonyl and (C₁-C₃)alkoxy-carbonyl; R¹³ is selected from the group consisting of (C₃-C₄) branched alkyl, (C₅-C₆) branched alkenyl, (C₅-C₇)cycloalkyl, and the radicals named in the definition of R¹; R² is hydrogen or (C₁-C₆)alkyl; R³ is phenyl, biphenyl, naphthyl, pyridyl, benzhydryl, thienyl or furyl, and R³ may optionally be substituted with from one to three substituents independently selected from the group consisting of halo, (C₁-C₁₀)alkyl optionally substituted with from one to three fluorine atoms and (C₁-C₁₀)alkoxy optionally substituted with from one to three fluorine atoms; Y is (CH₂)_(l) wherein l is an integer from one to three or Y is a group of the formula

Z is oxygen, sulfur, amino, (C₁-C₃)alkylamino or (CH₂)_(n) wherein n is zero, one or two; o is two or three; p is zero or one; R⁴ is furyl, thienyl, pyridyl, indolyl, biphenyl, or phenyl optionally substituted with one or two substituents independently selected from the group consisting of halo, (C₁-C₁₀)alkyl optionally substituted with from one to three fluorine atoms, (C₁-C₁₀)alkoxy optionally substituted with from one to three fluorine atoms, carboxy, (C₁-C₃)alkoxycarbonyl and benzyloxycarbonyl; R⁵ is thienyl, biphenyl or phenyl optionally substituted with one or two substituents independently selected from the group consisting of halo, (C₁-C₁₀)alkyl optionally substituted with from one to three fluorine atoms and (C₁-C₁₀)alkoxy optionally substituted with from one to three fluorine atoms; each of the two dashed lines in formula (N) and the dashed line in formula (II) represents an optional double bond that may optionally exist when Q is a group of the formula (II); X is (CH₂)_(q) wherein q is an integer from 1 to 6, and wherein any one of the carbon-carbon single bonds in said (CH₂)_(q) may optionally be replaced by a carbon-carbon double bond, and wherein any one of the carbon atoms of said (CH₂)_(q) may optionally be substituted with R⁸, and wherein any one of the carbon atoms of said (CH₂)_(q) may be substituted with R⁹; m is an integer from 0 to 8, and any one of the carbon-carbon single bonds of (CH₂)_(m) may optionally be replaced by a carbon-carbon double bond, or a carbon-carbon triple bond, and any one of the carbon atoms of (CH₂)_(m) may optionally be substituted with R¹¹; R⁶ is a radical selected from the group consisting of hydrogen, (C₁-C₆) straight or branched alkyl, (C₃-C₇) cycloalkyl wherein one of the carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; aryl selected from the group consisting of biphenyl, phenyl, indanyl and naphthyl; heteroaryl selected from the group consisting of thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; phenyl(C₂-C₆)alkyl, benzhydryl and benzyl, wherein each of said aryl and heteroaryl groups and the phenyl moieties of said benzyl, phenyl(C₂-C₆)alkyl and benzhydryl may optionally be substituted with one or more substituents independently selected from the group consisting of halo, nitro, (C₁-C₁₀)alkyl optionally substituted with from one to three fluorine atoms, (C₁-C₁₀)alkoxy optionally substituted with from one to three fluorine atoms, amino, hydroxy-(C₁-C₆)alkyl, (C₁-C₆)alkoxy-(C₁-C₆)alkyl, (C₁-C₆)alkylamino, (C₁-C₆)alkyl-O—C(O)—, (C₁-C₆)alkyl-O—C(O)—C-(C₁-C₆)alkyl, (C₁-C₆)alkyl-C—(O)—(O)—, (C₁-C₆)alkyl-C(O)(C₁-C₆)alkyl-O—, (C₁-C₆)alkyl-C(O), (C₁-C₆)alkyl-C(O)(C₁-C₆)alkyl-, di-(C₁-C₆)alkylamino, —C(O)NH-(C₁-C₆)-alkyl-, (C₁-C₆)alkyl-C(O)—NH-(C₁-C₆)alkyl, —NHC(O)H and NHC(O)—(C₁-C₆)alkyl; and wherein one of the phenyl moieties of said benzhydryl may optionally be replaced by naphthyl, thienyl, furyl or pyridyl; R⁷ is hydrogen, phenyl or (C₁-C₆)alkyl; or R⁶ and R⁷, together with the carbon to which they are attached, form a saturated carbocyclic ring having from 3 to 7 carbon atoms wherein one of said carbon atoms may optionally be replaced by oxygen, nitrogen or sulfur; R⁸ and R⁹ are each independently selected from the group consisting of hydrogen, hydroxy, halo, amino, oxo (═O), nitrile, hydroxy-(C₁-C₆)alkyl, (C₁-C₆)-alkoxy-(C₁-C₆)alkyl, (C₁-C₆)alkylamino, di-(C₁-C₆)alkylamino, (C₁-C₆)alkoxy, (C₁-C₆)alkyl-O—C(O)—, (C₁-C₆)alkyl-O—C(O)—(C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—O, (C₁-C₆)alkyl-C(O)-(C₁-C₆)alkyl-O—, (C₁-C₆)alkyl-C(O)—, (C₁-C₆)alkyl-C(O)—(C₁-C₆)alkyl-, and the radicals set forth in the definition of R⁶; R¹⁰ is NHCR¹², NHCH₂R_(hu 12), NHSO₂R¹², or one of the radicals set forth in any of the definitions of R⁶, R⁸ and R⁹; R¹¹ is oximino (═NOH) or one of the radicals set forth in any of the definitions of R⁶, R⁸ and R⁹; and R¹² is (C₁-C₆)alkyl, hydrogen, phenyl(C₁-C₆)alkyl or phenyl optionally substituted with (C₁-C₆)alkyl, and with the provisos that (a) when m is O, R¹¹ is absent; (b) neither R⁸, R⁹, R¹⁰ nor R¹¹ can form, together with the carbon to which it is attached, a ring with R⁷; (c) when Q is a group of the formula (VIII), R⁸ and R⁹ cannot be attached to the same carbon atom; (d) when R⁸ and R⁹ are attached to the same carbon atom, then either each of R⁸ and R⁹ is independently selected from hydrogen, fluoro, (C₁-C₆)alkyl, hydroxy-(C₁-C₆)alkyl and (C₁-C₆)alkoxy-(C₁-C₆)alkyl, R⁸ and R⁹, together with the carbon to which they are attached, form a (C₃-C₆) saturated carbocyclic ring that forms a spiro compound with the nitrogen-containing ring to which they are attached; (e) the nitrogen of formula (N) cannot be double bonded to both Q and the substituted benzyl group to which it is attached; (f) when Q is a group of the formula (VII) and q is 2 and either R⁸ or R⁹ is 5-hydroxy-(C₁-C₆)alkyl or 5-(C₁-C₆)alkoxy-(C₁-C₆)alkyl, then the other of R⁸ or R⁹ is either 5-(C₁-C₆)alkyl or hydrogen; (g) when Q is a group of the formula (VII) and q is 2, then neither R⁸ or R⁹ is 4-hydroxy-(C₁-C₆)alkyl or 4-(C₁-C₆)alkoxy-(C₁-C₆)alkyl; and (h) when neither X¹, X² nor X³ is a fluorinated alkoxy group, at least one of R¹, R³, R⁴, R⁵, R⁶, R⁷ and R¹³ is an aryl group substituted with a fluorinated alkoxy group; and pharmaceutically acceptable acid addition and base salts of compounds of the formula (N);

wherein Y is (CH₂)_(n) wherein n is an integer from 1 to 6, and wherein any one of the carbon-carbon single bonds in said (CH₂)_(n) may optionally be replaced by a carbon-carbon double bond, and wherein any one of the carbon atoms of said (CH₂)_(n) may optionally be substituted with R⁴, and wherein any one of the carbon atoms of said (CH₂)_(n) may be substituted with R⁷; m is an integer from 0 to 8, and any one of the carbon-carbon single bonds of (CH₂)_(m) may optionally be replaced by a carbon-carbon double bond, or a carbon-carbon triple bond, and any one of the carbon atoms of said (CH₂)_(m) may be optionally substituted with R⁸; R¹ is hydrogen or (C₁-C₈)alkyl optionally substituted with hydroxy, alkoxy or fluoro; R² is a radical selected from the group consisting of hydrogen, (C₁-C₆) straight or branched alkyl, (C₃-C₇)cycloalkyl wherein one of the carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; aryl selected from the group consisting of phenyl and naphthyl; heteroaryl selected from the group consisting of indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, triazolyl, tetrazolyl and quinolyl; phenyl(C₂-C₆)alkyl, benzhydryl and benzyl, wherein each of said aryl and heteroaryl groups and the phenyl moieties of said benzyl, phenyl(C₂-C₆)alkyl and benzhydryl may optionally be substituted with one or more substituents independently selected from halo, nitro, (C₁-C₆)alkyl, (C₁-C₆)alkoxy, trifluoromethyl, amino, (C₁-C₆)alkylamino, (C₁-C₆)alkyl-O—C—(O)—, (C₁-C₆)alkyl-O—C(O)—(C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—C, (C₁-C₆)alkyl-C(O)-(C₁-C₆)alkyl-O—, (C₁-C₆)alkyl-C(O)—, (C₁-C₆)alkyl-C (O)-(C₁-C₆)alkyl-, di-(C₁-C₆) alkylamino, —C(O)NH-(C₁-C₆)alkyl-, (C₁-C₆)alkyl-C(O)—NH-(C₁-C₆)alkyl, —NH(O)CH and —NH(O)C-(C₁-C₆)alkyl; and wherein one of the phenyl moieties of said benzhydryl may optionally be replaced by naphthyl, thienyl, furyl or pyridyl; R⁵ is hydrogen, phenyl or (C₁-C₆)alkyl; or R² and R⁵, together with the carbon to which they are attached, form a saturated carbocyclic ring having from 3 to 7 carbon atoms wherein one of said carbon atoms may optionally be replaced by oxygen, nitrogen or sulfur; R³ is aryl selected from the group consisting of phenyl and naphthyl; heteroaryl selected from the group consisting of indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; and cycloalkyl having 3 to 7 carbon atoms wherein one of said carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said (C₃-C₇)cycloalkyl may optionally be substituted with one or two substituents, each of said substituents being independently selected from the group consisting of halo, nitro, (C₁-C₆)alkyl, (C₁-C₆)alkoxy, trifluoromethyl, phenyl, amino, (C₁-C₆)alkylamino, —C(O)NH-(C₁-C₆)alkyl, (C₁-C₆)alkyl C(O)—NH-(C₁-C₆)alkyl, —NHC(O)H and —NHC(O)-(C₁-C₆)alkyl; R⁴ and R⁷ are each independently selected from the group consisting of hydrogen, hydroxy, halo, amino, oxo (═O), nitrile, (C₁-C₆)alkylamino, di-(C₁-C₆)alkylamino, (C₁-C₆)alkoxy, (C₁-C₆)alkyl-O—C(O)—, C₁-C₆)alkyl-O—C(O)-(C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—O, (C₁-C₆)alkyl-C(O)—(C₁-C₆)alkyl-O, hydroxy-(C₁-C₆)alkyl, (C₁-C₆)alkoxy(C₁-C₆)alkyl, (C₁-C₆)alkyl-C(O)—, (C₁-C₆)alkyl-C(O)-(C₁-C₆)alkyl- and the radicals set forth in the definition of R²; R ⁶ is NHC(O)R⁹, NHCH₂R⁹, SO₂R⁹, or one of the radicals set forth in any of the definitions of R², R⁴ and R⁷; R⁸ is oximino (═NOH) or one of the radicals set forth in any of the definitions of R², R⁴ and R⁷; R⁹ is (C₁-C₆)alkyl, hydrogen, phenyl or phenyl(C₁-C₆)alkyl; with the provisos that (a) when m is O, R⁸ is absent; (b) neither R⁴, R⁶, R⁷ nor R⁸ can form, together with the carbon to which it is attached, a ring with R⁵; (c) when R⁴ and R⁷ are attached to the same carbon atom, then either each of R⁴ and R⁷ is independently hydrogen, fluoro or (C₁-C₆)alkyl, or R¹ and R⁷, together with the carbon to which they are attached, form a (C₃-C₆) saturated carbocyclic ring that forms a spiro compound with the nitrogen-containing ring to which they are attached; (d) when n is 2 and either R⁴ or R⁷ is 5-hydroxy(C₁-C₆)alkyl or 5-(C₁-C₆)alkoxy-(C₁-C₆)alkyl, then the other of R⁴ and R⁷ is hydrogen; (e) when n is 2, neither R⁴ nor R⁷ is 4-hydroxy(C₁-C₆)alkyl or 4-(C₁-C₆)alkoxy(C₁-C₆)alkyl; and (f) in all compounds of the formula (S), either R³ is aryl substituted with at least one phenyl group, or one or both of R⁴ and R⁷ is hydroxy-(C₁-C₆)alkyl or (C₁-C₆)alkoxy(C₁-C₆)alkyl;

wherein n is 1, 2 or 3 and where any carbon atom of (CH₂)_(n) may be substituted by R⁴ and/or R⁵; X represents O or S; R¹ represents phenyl optionally substituted by 1, 2 or 3 groups selected from the group consisting of C₁₋₆ alkyl, C₂₋₆ alkenyl; C₂₋₆ alkynyl, halo, cyano, nitro, trifluoromethyl, trimethylsilyl, —OR^(a), SR^(a), SOR^(a), SO₂R^(a), —NR^(a)R^(b), —NR^(a)COR^(b), —NR^(a)CO₂R^(b), CO₂R^(a), or —CONR^(a)R^(b); R² represents aryl selected from the group consisting of phenyl and naphthyl; heteroaryl selected from the group consisting of indazolyl, thienyl, furyl, pyridyl, thiazolyl, tetrazolyl and quinolyl; benzhydryl; or benzyl; wherein each aryl or heteroaryl moiety may be substituted by C₁₋₆ alkyl, C₁₋₆ alkoxy, halo or trifluoromethyl; R⁴ and R⁵ each independently represent H, halo, CH₂OR⁹, C₁₋₆ alkyl, oxo, CO₂R¹⁰ or CONR¹⁰R¹¹; R⁸ represents H, COR⁹, CO₂R¹⁰, COCONR¹⁰R¹¹, COCO₂R¹⁰ or C₁₋₆ alkyl optionally substituted by a group selected from the group consisting of CO₂R¹⁰, CONR¹⁰R¹¹, hydroxy, cyano, COR⁹, NR¹⁰R¹¹, C(NOH)NR¹⁰R¹¹, CONHphenyl-(C₁₋₄alkyl), COCO₂R¹⁰, COCONR¹⁰R¹¹ and phenyl optionally substituted by one or more substituents selected from the group consisting of C₁₋₆alkyl, C₁₋₆alkoxy, halo and trifluoromethyl; R^(a) and R^(b) each independently represent H, C₁₋₆alkyl, phenyl or trifluoromethyl; R⁹ represents H, C₁₋₆alkyl or phenyl; and R¹⁰ and R¹¹ each independently represent H or C₁₋₆alkyl; in combination with an effective amount of a 5HT₃ antagonist which is selected from the group consisting of ondansetron, granisetron and metoclopramide.
 4. A method for the treatment of emesis in a mammal comprising administering to said mammal an effective amount of an NK₁ antagonist which is (2S,3S)-2-phenyl-3-(2-trifluoromethoxybenzyl)aminopiperidine in combination with a 5HT₃ antagonist which is ondansetron. 